MEDICARE: MISS ANNE ELIZABETH FULLER MPAS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PAL-2779	CO
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1659428209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNE ELIZABETH FULLER MPAS, PA-C

Provider Business Mailing Address
First Line	:	7490 SUTHERLAND CIRCLE
Second Line	:	BLDG. 7490
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4055
Country	:	US
Telephone Number	:	719-524-2209
Fax Number	:	719-524-5405

Provider Business Practice Location Address
First Line	:	7490 SUTHERLAND CIRCLE
Second Line	:	BLDG. 7490
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4055
Country	:	US
Telephone Number	:	719-524-2209
Fax Number	:	719-524-5405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	01/30/2025

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