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General NPI Number Information
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NPI Number | 1396625570
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Entity Type | Organization
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Legal Business Name | FULLER LIFE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/06/2025
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 130 HUNTER CT STE 3
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7032
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Country | US
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Telephone | 270-904-5104
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Fax |
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Provider Business Mailing Address
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Address Line | 431 CLAYPOOL BOYCE RD
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City | ALVATON
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State | KY
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Zip | 42122-8732
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Country | US
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Telephone | 270-904-5104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINA WATT FULLER
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Credential | LPCC-S
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Telephone | 270-791-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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