Individual
KATELYN MARISSA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0100
(843) 792-2300
Mailing address
3245 GLENN MCCONNELL PKWY UNIT 1122, CHARLESTON, SC 29414-8166
(901) 355-7102
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/07/2026
Last updated
05/07/2026
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