Healthcare Provider Details

I. General information

NPI: 1871419788
Provider Name (Legal Business Name): JOCELIN FULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 JOHN F KENNEDY BLVD APT 1822
NORTH LITTLE ROCK AR
72116-5623
US

IV. Provider business mailing address

5901 JOHN F KENNEDY BLVD APT 1822
NORTH LITTLE ROCK AR
72116-5623
US

V. Phone/Fax

Practice location:
  • Phone: 312-882-2375
  • Fax:
Mailing address:
  • Phone: 312-882-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: