Individual
JOHNNY RAY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
131 COUNTY ROAD 3102, CENTER, TX 75935-5581
(936) 591-9885
Mailing address
364 COUNTY ROAD 1165, CENTER, TX 75935-6930
(936) 332-3232
(936) 332-3232
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
206588
TX
Other
Enumeration date
02/18/2018
Last updated
02/18/2018
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