Individual
KELLY R FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2344 RIVERSIDE DR, DANVILLE, VA 24540-4212
(540) 345-3556
Mailing address
PO BOX 8310, ROANOKE, VA 24014-0310
(540) 345-3556
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024180000
VA
Other
Enumeration date
11/11/2020
Last updated
11/11/2020
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