Individual
KACIE LEIGH FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
234 KELLER PARK BLVD, TUSCUMBIA, AL 35674-1417
(256) 381-6963
(256) 381-6018
Mailing address
234 KELLER PARK BLVD, TUSCUMBIA, AL 35674-1417
(256) 381-6963
(256) 381-6018
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-113225
AL
Other
Enumeration date
01/28/2013
Last updated
01/28/2013
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