MRS. KIMOTHY ANN FULK


Address: 11020 State Route 250, Lawrenceville, IL 62439-3379
Phone: 6189432609

MRS. KIMOTHY ANN FULK (NPI# 1770515728) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1770515728
Entity Type Individual
Full Name MRS. KIMOTHY ANN FULK
Credential APN NP C
Practice Address 11020 State Route 250
Lawrenceville
IL 62439-3379
Mailing Address Po Box 516
Lawrenceville
IL 62439-0516
Practice Telephone 6189432609
Practice Fax Number 6189436409
Mailing Telephone 6189432609
Mailing Fax Number 6189436409
Enumeration Date 2006-07-07
Last Update Date 2019-09-09
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2200X Nurse Practitioner
Specialization: Adult Health
209005713 IL Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL BCBS 5132004 01
IL HEALTH ALLIANCE INS 109800 01
IL HEALTH LINK INS 731354 01
FIRST HEALTH 1729885 01
IL 376006178007 05
UNITED HEALTHCARE 838915 01

Office Location

Street Address 11020 STATE ROUTE 250
City LAWRENCEVILLE
State IL
Zip Code 62439-3379

Providers in the same location

NPI Name Taxonomy Address Enumeration
1417511619 Jodi Stone Counselor 11020 State Route 250, Lawrenceville, IL 62439-3379 2019-04-24
1396200531 Andrew F. Caldwell Counselor 11020 State Route 250, Lawrenceville, IL 62439 2019-02-01
1679065742 Marissa Beth Hake Registered Nurse 11020 State Route 250, Lawrenceville, IL 62439-3379 2018-06-04
1649773946 Angela Parish Nurse Practitioner 11020 State Route 250, Lawrenceville, IL 62439-3379 2018-03-13
1144739194 Logan Kermicle Counselor 11020 State Route 250, Lawrenceville, IL 62439 2017-09-21
1578018172 Leslie K Shan Counselor 11020 State Route 250, Lawrenceville, IL 62439 2016-08-24
1982055687 David Patrick Penk Counselor 11020 State Route 250, Lawrenceville, IL 62439 2016-06-24
1366824559 Emily Michele Brown Counselor 11020 State Route 250, Lawrenceville, IL 62439 2015-06-24
1205233822 Jenna Gonzalez Counselor 11020 State Route 250, Lawrenceville, IL 62439-3379 2014-11-25
1497151641 Sarah Fehrenbacher Counselor 11020 State Route 250, Lawrenceville, IL 62439-3379 2014-11-17
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1801406590 Allyson Fiscus Nurse Practitioner 11020 Il-250, Lawrenceville, IL 62439 2020-08-06
1164071700 Lauren E Welton Case Manager/Care Coordinator 11362 Country Club Road, Lawrenceville, IL 62439 2019-09-06
1962063354 Connie Deckard Counselor Lawrence County Health Department Behavior Health, 11020 State Route 250, Lawrenceville, IL 62439 2019-06-26
1225485527 Megan Joergens Social Worker 11120 State Route 250, Lawrenceville, IL 62439 2016-05-17
1235509456 Christy M Wimberly Private Vehicle 1417 Dubios St., Lawrenceville, IL 62439 2015-09-30
1144637521 Joy Singson Uy Physical Therapist 2101 James St United Methodist Village North, Lawrenceville, IL 62439 2014-07-17
1760791792 Lawrence Co Secured Medical Transport (VAN) 2009 Lexington Ave, Lawrenceville, IL 62439 2010-09-24
1134358922 Lawrence County Health Department Public Health or Welfare Rural Route3 Box 430, Lawrenceville, IL 62439 2009-07-14
1366678161 Judith Joan Phipps Counselor Rr1 Box 277, Lawrenceville, IL 62439 2009-06-08
1366648784 S. Hurn Baek Radiology Lawrence County Memorial Hospital, Radiology, 2200 W. State St., Lawrenceville, IL 62439 2007-06-22
Find all providers in zip 62439

Taxonomy Information

Taxonomy Code 363LA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Adult Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1033777826 Jolly Maria Thomas Nurse Practitioner 1867 Anthony Nane Ct, Lawrenceville, GA 30043-3991 2019-06-05
1548292667 Bonnie J Cross Nurse Practitioner Rr #3 Box 414, Lawrenceville, IL 62439 2006-07-07
1912533548 Frankie Ann Mitchell Nurse Practitioner 1925 Old Peachtree Rd Ne, Lawrenceville, GA 30043-2822 2020-03-16
1003454687 Katherine Elaine Campbell Thomas Nurse Practitioner 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 2019-12-14
1902376197 Elizabeth Ann Tursi Nurse Practitioner 168 Franklin Corner Rd Bldg 1, Lawrenceville, NJ 08648-2529 2018-11-29
1114443967 Kristen Copeland Nurse Practitioner 631 Professional Dr Ste 450, Lawrenceville, GA 30046-3370 2017-08-14
1093260564 Rebeca C Klatt Nurse Practitioner 631 Professional Dr, Suite 450, Lawrenceville, GA 30046-3367 2016-08-24
1942619093 Elizabeth Ann Ziegler Nurse Practitioner 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 2014-08-02
1558795229 Marguerite Horen Bobon Nurse Practitioner 631 Professional Dr Ste 360, Lawrenceville, GA 30046-3370 2013-08-29
1992045462 Rachel Elizabeth Nejem Nurse Practitioner 771 Old Norcross Rd Ste 200, Lawrenceville, GA 30046-4980 2013-02-21
Find all providers in LAWRENCEVILLE

Competitor

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City LAWRENCEVILLE
Zip Code 62439

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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