Individual
DR. A NEDRA YULONDA FULLER TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2828 FIRST AVENUE, SUITE 203, HUNTINGTON, WV 25702-1236
(304) 522-3692
(304) 522-3693
Mailing address
2828 FIRST AVENUE, SUITE 203, HUNTINGTON, WV 25702-1236
(304) 522-3692
(304) 522-3693
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
10387
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2707084
—
OH
05
—
3810007238
—
WV
01
—
P00357027
RR MEDICARE
WV
Enumeration date
11/08/2006
Last updated
11/19/2009
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