| Doctor Name: | VIRGINIA FULLER |
| NPI Number: | 1265664171 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | TC033 |
| Business Practice Address: | 713 Broadway St Suite 301 Paintsville, KY - 412401465 |
| Business Phone Number: | 6067892427 |
| Business Fax Number: | 6067891538 |
| Mailing Address: | Po Box 1810, PRESTONSBURG |
| State: | KY |
| Postal Code: | 416535810 |
| Phone Number: | 6068863831 |
| Fax Number: | 6068863440 |
| NPI Enumeration Date: | 08/12/2009 |
| NPI Last Update Date: | 01/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | TC033 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |