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General NPI Number Information
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NPI Number | 1730045766
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Entity Type | Organization
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Legal Business Name | FULFILLED MIND & WELLNESS PLLC
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Dates
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Enumeration Date | 01/03/2026
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 4117 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98373-3697
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Country | US
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Telephone | 253-648-0115
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Fax | 253-237-9314
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Provider Business Mailing Address
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Address Line | 4117 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98373-3697
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Country | US
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Telephone | 253-648-0115
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Fax | 253-237-9314
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STARLA HALVERSON
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Credential | ARNP, PMHNP-BC
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Telephone | 509-833-4788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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