Healthcare Provider Details

I. General information

NPI: 1528664117
Provider Name (Legal Business Name): FULL FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 S MAIN ST STE 5A
MORGANTOWN KY
42261-9832
US

IV. Provider business mailing address

PO BOX 445
HARTFORD KY
42347-0445
US

V. Phone/Fax

Practice location:
  • Phone: 270-274-9221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID C FULLER
Title or Position: OWNER/MANAGER
Credential: DPT
Phone: 270-256-2932