Individual
JENNIFER LEE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1302 S LYNN LN, IDABEL, OK 74745-6860
(580) 286-3993
Mailing address
1302 S LYNN LN, IDABEL, OK 74745-6860
(580) 286-3993
(580) 286-3967
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
204314
OK
Other
Enumeration date
07/19/2021
Last updated
08/10/2021
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