MS. CAROLYN STARR FULLMER (NPI# 1275686669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275686669 |
| Entity Type | Individual |
| Full Name | MS. CAROLYN STARR FULLMER |
| Credential | PAC |
| Practice Address |
410 E King St Chewelah WA 99109-0137 |
| Mailing Address |
Po Box 137 Chewelah WA 99109-0137 |
| Practice Telephone | 5099358711 |
| Practice Fax Number | 5099354882 |
| Mailing Telephone | 5099358711 |
| Mailing Fax Number | 5099354882 |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2008-06-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA10003285 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WA STATE L&I | 0159376 | 01 |
| WA | 8511230 | 05 | |
| WA | WA STATE LICENSE | PA10003285 | 01 |
| Street Address |
410 E KING ST |
| City | CHEWELAH |
| State | WA |
| Zip Code | 99109-0137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528128907 | Kimberlyn Ann Johnstone | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-08 |
| 1063632388 | Chewelah Associated Physicians | Family Medicine | 410 E King St, Chewelah, WA 99109 | 2007-04-27 |
| 1316167638 | Chewelah Associated Physicians | Family Medicine | 410 E King St, Chewelah, WA 99109 | 2007-04-27 |
| 1104971365 | Chewelah Associated Physicians Ps | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2007-01-25 |
| 1447310347 | James Gregory Sisco | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-11 |
| 1821158734 | Robin Nelson Moyer | Family Medicine | 410 E King St, Chewelah, WA 99109-0137 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609322528 | Providence Health & Services | In Home Supportive Care | 110 S. Third Street E., Chewelah, WA 99109 | 2016-08-31 |
| 1639525157 | Shelley Gail Schreibman | Specialist | 101 N Park Street, Po, Chewelah, WA 99109 | 2016-05-13 |
| 1518361831 | David Stroyan | Pharmacist | 518 E Clay, New Health Programs, Chewelah, WA 99109 | 2014-10-15 |
| 1942554712 | Renee S Thompson | Psychologist | 208 E Clay St, Chewelah, WA 99109 | 2012-11-01 |
| 1356616759 | Paul Michael Cockerham | Physical Therapist | 101 N. Park St., Chewelah, WA 99109 | 2012-03-19 |
| 1669768479 | Lori S King | Veterinarian | 1505 N Pinebrook Dr, Chewelah, WA 99109 | 2011-06-21 |
| 1619268281 | Providence Physician Services Co | Family Medicine | 100 W. South Ave Chewelah, Chewelah, WA 99109 | 2011-04-29 |
| 1245557917 | Providence Physician Services Co | Obstetrics & Gynecology | 518 Clay Street, Chewelah, WA 99109 | 2010-04-21 |
| 1033340088 | Scott Anthony Lake | Dentist | 616 E Main, Chewelah, WA 99109 | 2009-08-06 |
| 1659560787 | Robin D Bowman | Counselor | 2264 C. Sand Canyon Road, Chewelah, WA 99109 | 2007-10-15 |
| Find all providers in zip 99109 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639298268 | Michael S Patterson | Physician Assistant | 500 W Webster, Chewelah, WA 99109 | 2007-03-28 |
| 1851518625 | Michael R Dunniway | Physician Assistant | 518 E Clay Ave, Chewelah, WA 99109-8947 | 2007-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831790591 | Bailey Mantha-nagrant | Physician Assistant | 7912 170th Ave Ne Unit 301, Redmond, WA 98052-0907 | 2020-11-07 |
| 1518567791 | Addison Christine Richert | Physician Assistant | 121 Kingfisher Pl, Port Hadlock, WA 98339-8733 | 2020-10-28 |
| 1992312177 | Robert Monsees | Physician Assistant | 490 Packwood Ln, Ellensburg, WA 98926-8027 | 2020-09-30 |
| 1649887548 | Jesse E Davis | Physician Assistant | 3512 Serene Way, Lynnwood, WA 98087-5202 | 2020-09-25 |
| 1558977066 | Kimberly Ho | Physician Assistant | 23004 88th Ave W, Edmonds, WA 98026-8616 | 2020-09-20 |
| 1770198954 | Ashish Chaudhary | Physician Assistant | 1215 Dexter Ave N Apt 704, Seattle, WA 98109-3567 | 2020-09-14 |
| 1144835422 | Juleeann Stocking | Physician Assistant | 1517 17th Ave S, Seattle, WA 98144-3522 | 2020-09-13 |
| 1891309555 | Andrew Allyn Bloom | Physician Assistant | 5889 Bow St, Bow, WA 98232-8620 | 2020-09-01 |
| 1558973909 | Margaret Webster | Physician Assistant | 6501 36th Ave Nw, Seattle, WA 98117-6010 | 2020-08-18 |
| 1033720495 | Riley Richardson | Physician Assistant | 1008 E Windemere Ct, Spokane, WA 99223-6228 | 2020-08-11 |
| Find all providers with the same taxonomy | ||||
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| 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.