Individual
KIERSTEN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
989 E 500 S, HEBER CITY, UT 84032-3939
(435) 503-5643
Mailing address
989 E 500 S, HEBER CITY, UT 84032-3939
(435) 503-5643
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194007724
MEDICARE UPIN,MEDICARE PIN, MEDICARE OSCAR/CERTIFICATION, MEDICARE NSC, MEDICAID
UT
Enumeration date
11/16/2015
Last updated
11/16/2015
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