Individual
KELLI M. FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
802 MEL CARNAHAN DR STE 215, HILLSBORO, MO 63050
(636) 543-2290
Mailing address
9 CLAIBORNE PLACE, WEBSTER GROVES, MO 63119
(314) 920-9517
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
131425
MO
163W00000X
Registered Nurse
209-003174
IL
163W00000X
Registered Nurse
2533252
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
131425
MO
Other
Enumeration date
04/18/2009
Last updated
07/01/2019
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