Individual
RESHANSHARDAYE KIE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1414 AMHURST AVE, NORMAN, OK 73071-1436
(405) 532-5813
Mailing address
4436 NW 50TH ST, OKLAHOMA CITY, OK 73112-2212
(405) 532-5813
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
10/15/2024
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