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General NPI Number Information
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NPI Number | 1285549410
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Entity Type | Individual
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Provider Name | KRYSTAL FULLMER
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 205 N MAIN ST
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City | SPANISH FORK
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State | UT
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Zip | 84660-1726
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Country | US
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Telephone | 385-223-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 9934 N 4680 W
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City | CEDAR HILLS
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State | UT
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Zip | 84062-8706
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Country | US
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Telephone | 801-678-3995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | UT
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