Individual
TRACIE FULLOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3162 W MARTIN LUTHER KING BLVD STE 13-14, FAYETTEVILLE, AR 72704-7679
(479) 935-4834
(479) 249-9879
Mailing address
607 HAMPTON CIR APT G, JACKSON, MS 39211-2334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-11276
AR
Other
Enumeration date
03/31/2016
Last updated
06/19/2019
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