Individual
DESTINY MARIE FULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
102 W JOHN ROWAN BLVD, BARDSTOWN, KY 40004-2663
(502) 348-7880
Mailing address
108 BROOKSHADE DR, MOUNT WASHINGTON, KY 40047-5583
(502) 759-0635
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4047688
KY
363LP2300X
Primary Care Nurse Practitioner
Primary
4047688
KY
Other
Enumeration date
02/18/2026
Last updated
03/07/2026
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