Individual
AUDREY MIRIAM FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
997 HAMPSHIRE LN, RICHARDSON, TX 75080-8105
(972) 479-0400
(972) 479-9435
Mailing address
5825 STAGS LEAP APT 4077, THE COLONY, TX 75056-6909
(717) 513-6027
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TEMPORARY
TX
Other
Enumeration date
06/28/2025
Last updated
06/28/2025
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