Individual
PAULA KNOD FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9601 INTERSTATE 630 EXIT 7, EXIT 7, LITTLE ROCK, AR 72205-7202
(501) 202-2093
Mailing address
112 QUAPAW TRL, MAUMELLE, AR 72113-5856
(501) 416-0687
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C00893
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138802701
—
AR
Enumeration date
09/20/2006
Last updated
11/04/2019
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