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General NPI Number Information
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NPI Number | 1427472083
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Entity Type | Individual
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Provider Name | JO L FULLER APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 2401 N COMMERCE ST
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City | ARDMORE
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State | OK
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Zip | 73401-1280
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Country | US
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Telephone | 580-226-0543
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Fax | 580-226-2284
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Provider Business Mailing Address
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Address Line | PO BOX 216
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City | ARDMORE
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State | OK
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Zip | 73402-0216
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Country | US
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Telephone | 580-221-7500
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Fax | 580-490-9406
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 75953
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License Number State | OK
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