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NPI Code Detail

MEDICARE: ANDREW MACKENZIE FULLER CF-SLP

MEDICARE: ANDREW MACKENZIE FULLER CF-SLP
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
1235Z00000XSpeech-Language Pathologist2202011795VA

General Provider Information

NPI Number : 1295303196
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW MACKENZIE FULLER CF-SLP
Provider Business Mailing Address
First Line : 935 KESWICK BLVD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40217-2136
Country : US
Telephone Number : 502-341-9369
Fax Number :
Provider Business Practice Location Address
First Line : 10401 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1151
Country : US
Telephone Number : 702-207-4242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2021
Last Update Date : 04/20/2026

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Directions to “ ANDREW MACKENZIE FULLER CF-SLP” Practice Location

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