MEDICARE: KAYLA LEANN FULLER MSN, APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2020018079	MO

General Provider Information

NPI Number	:	1033790159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA LEANN FULLER MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1054 STATE HIGHWAY 25
Second Line	:
City	:	BERNIE
State	:	MO
Zip	:	63822-7215
Country	:	US
Telephone Number	:	573-281-9637
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 N DOUGLASS ST
Second Line	:
City	:	MALDEN
State	:	MO
Zip	:	63863-1351
Country	:	US
Telephone Number	:	573-276-3884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	02/22/2024

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