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General NPI Number Information
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NPI Number | 1821138470
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Entity Type | Organization
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Legal Business Name | KYLE FULLER APRN LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 19 S WALNUT ST. STE C
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City | WAUREGAN
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State | CT
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Zip | 06387
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Country | US
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Telephone | 860-207-8160
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Fax | 860-207-8170
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Provider Business Mailing Address
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Address Line | 19 S WALNUT ST. STE C P. O. BOX 530
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City | WAUREGAN
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State | CT
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Zip | 06387
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Country | US
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Telephone | 860-207-8160
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Fax | 860-207-8170
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | MS. KYLE J FULLER
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Credential | APRN
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Telephone | 860-207-8160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 002043
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 002043
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License Number State | CT
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