Individual
KAYLA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-4564
Mailing address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-4564
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1177
AK
363A00000X
Physician Assistant
25MP00600900
NJ
Other
Enumeration date
10/09/2014
Last updated
11/02/2022
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