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General NPI Number Information
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NPI Number | 1952544017
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Entity Type | Individual
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Provider Name | KELLI M. FULLER ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/18/2009
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 802 MEL CARNAHAN DR STE 215
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City | HILLSBORO
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State | MO
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Zip | 63050
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Country | US
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Telephone | 636-543-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CLAIBORNE PLACE
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City | WEBSTER GROVES
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State | MO
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Zip | 63119
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Country | US
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Telephone | 314-920-9517
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 209-003174
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 131425
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2533252
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 131425
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License Number State | MO
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