Individual
KRISTIN L FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
20905 PROFESSIONAL PLAZA, SUITE 330, ASHBURN, VA 20147
(703) 726-0003
(703) 726-6444
Mailing address
12011 LEE JACKSON MEMORIAL HIGHWAY, SUITE 504, FAIRFAX, VA 22033-3315
(703) 391-2031
(703) 273-3943
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003507
VA
363AM0700X
Medical Physician Assistant
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—
Other
Enumeration date
01/03/2011
Last updated
09/04/2013
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