Healthcare Provider Details

I. General information

NPI: 1730680372
Provider Name (Legal Business Name): JOSHUA J FULLENKAMP NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MERCER AVE
DECATUR IN
46733-2303
US

IV. Provider business mailing address

1100 MERCER AVE
DECATUR IN
46733-2303
US

V. Phone/Fax

Practice location:
  • Phone: 260-724-2145
  • Fax: 260-728-3852
Mailing address:
  • Phone: 260-724-2145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28194969A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007872A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: