Healthcare Provider Details

I. General information

NPI: 1902922875
Provider Name (Legal Business Name): RACHEL CATHLEEN FULLINGTON D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL CATHLEEN KELLY DO

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7383 E TANQUE VERDE RD
TUCSON AZ
85715-3475
US

IV. Provider business mailing address

PO BOX 43130
TUCSON AZ
85733-3130
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-3434
  • Fax: 520-318-3435
Mailing address:
  • Phone: 520-722-3777
  • Fax: 520-296-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-06468
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number005098
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: