Individual
MRS. KIMBERLY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, ACNP - BS
Contact information
Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Mailing address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
R853474
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
R853474
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07281200
—
MS
05
—
1347574
—
LA
Enumeration date
08/18/2008
Last updated
03/16/2009
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