Individual
TREVECCA MICHELLE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3131 CUSTER DR STE 4A, LEXINGTON, KY 40517-4006
(859) 298-5629
Mailing address
94 KINGSBURY LN, CYNTHIANA, KY 41031-4408
(859) 298-5629
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0310
HOME CARE
—
Enumeration date
01/23/2023
Last updated
02/08/2023
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