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Organization

KYLE FULLER APRN LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. KYLE J FULLER APRN (OWNER/SOLE PROPRIETOR)
(860) 207-8160
Entity
Organization

Contact information

Practice address
19 S WALNUT ST. STE C, WAUREGAN, CT 06387
(860) 207-8160
(860) 207-8170
Mailing address
19 S WALNUT ST. STE C, P. O. BOX 530, WAUREGAN, CT 06387
(860) 207-8160
(860) 207-8170

Taxonomy

Speciality
Code
Description
License number
State
364SF0001X
Family Health Clinical Nurse Specialist
002043
CT
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
002043
CT

Other

Enumeration date
02/06/2007
Last updated
10/22/2019
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