Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

John D Fulk, PA

Individual provider Physician Assistant · NPI 1063419679

John D Fulk, PA is a Physician Assistant in Normal, Illinois. Qualified in 1998, 28 years ago. Practices with Richland Memorial Hospital Inc, a 104-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
28
Licensed in
IL
In the registry since
2005
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1302 Franklin Ave Ste 4800
Normal, IL 61761-3551
Phone: (309) 454-5900
Fax: (309) 454-2820
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085001126 (IL)

Record details

NPI number1063419679
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 29, 2005
Last updated in NPPESApril 4, 2019
Mailing address1302 Franklin Ave, Suite 4800, Normal, IL 61761-3551

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Group practice Richland Memorial Hospital Inc — 104 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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