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NPI Code Detail

MEDICARE: ALICIA ROBIN FULLER

MEDICARE: ALICIA ROBIN FULLER
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1194303453
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA ROBIN FULLER
Provider Business Mailing Address
First Line : 2995 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8600
Country : US
Telephone Number : 573-712-2902
Fax Number :
Provider Business Practice Location Address
First Line : 2995 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8600
Country : US
Telephone Number : 573-712-2902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2021
Last Update Date : 03/30/2021

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Directions to “ ALICIA ROBIN FULLER ” Practice Location

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