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).
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 |
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 |
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 |
Street Address |
11020 STATE ROUTE 250 |
City | LAWRENCEVILLE |
State | IL |
Zip Code | 62439-3379 |
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 |
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 Code | 363LA2200X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Adult Health |
Definition to come... |
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 |
City | LAWRENCEVILLE |
Zip Code | 62439 |
Please comment or provide details below to improve the information on MRS. KIMOTHY ANN FULK.
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.