MEDICARE: JOCELIN FULLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)		AR
2	374J00000X	Doula		AR

General Provider Information

NPI Number	:	1871419788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCELIN FULLER

Provider Business Mailing Address
First Line	:	5901 JOHN F KENNEDY BLVD APT 1822
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5623
Country	:	US
Telephone Number	:	312-882-2375
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 JOHN F KENNEDY BLVD APT 1822
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5623
Country	:	US
Telephone Number	:	312-882-2375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2026
Last Update Date	:	06/25/2026

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Directions to “ JOCELIN FULLER ” Practice Location

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