Doctor Name: | KACIE LEIGH FULLER |
NPI Number: | 1790023679 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 1-113225 |
Business Practice Address: | 234 Keller Park Blvd Tuscumbia, AL - 356741417 |
Business Phone Number: | 2563816963 |
Business Fax Number: | 2563816018 |
Mailing Address: | 234 Keller Park Blvd, TUSCUMBIA |
State: | AL |
Postal Code: | 356741417 |
Phone Number: | 2563816963 |
Fax Number: | 2563816018 |
NPI Enumeration Date: | 01/28/2013 |
NPI Last Update Date: | 01/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1-113225 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |