MEDICARE: KRISTEN MICHELLE FULLER APRN

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	41769	TN
2	163W00000X	Registered Nurse	229002	TN

General Provider Information

NPI Number	:	1437879632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MICHELLE FULLER APRN

Provider Business Mailing Address
First Line	:	1644 GINGERWOOD DR
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37129-3537
Country	:	US
Telephone Number	:	615-785-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 CROMWELL DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-5616
Country	:	US
Telephone Number	:	615-309-9982
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	06/24/2026

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