Individual
NINO FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
300 WILSON ST, HENDERSON, TX 75652-5956
(903) 655-6536
Mailing address
300 WILSON ST, HENDERSON, TX 75652-5956
(903) 655-6536
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024180028
VA
363L00000X
Nurse Practitioner
Primary
AP140425
TX
363LA2100X
Acute Care Nurse Practitioner
0024180028
VA
363LA2100X
Acute Care Nurse Practitioner
866207
TX
363LA2100X
Acute Care Nurse Practitioner
AP140425
TX
363LA2100X
Acute Care Nurse Practitioner
GAA-NP000340
GA
Other
Enumeration date
12/20/2018
Last updated
11/30/2022
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