Individual
MS. ANDREA NICOLE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1411 MAIN ST, DALLAS, TX 75202-4052
(214) 749-4657
Mailing address
1985 CENTRAL EXPY N # 120, ALLEN, TX 75013-5753
(972) 962-9100
(512) 782-9316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10919
TX
Other
Enumeration date
10/11/2016
Last updated
07/27/2021
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