MEDICARE: MRS. DALE FULLER FNP

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	AP110735	TX

General Provider Information

NPI Number	:	1255462735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DALE FULLER FNP

Provider Business Mailing Address
First Line	:	PO BOX 35629
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0629
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:	214-231-2159

Provider Business Practice Location Address
First Line	:	6317 HARRIS PKWY
Second Line	:	STE.300
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4256
Country	:	US
Telephone Number	:	817-361-6900
Fax Number	:	817-522-1968

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	02/03/2025

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