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NPI Code Detail

MEDICARE: MS. KELLI LYNNE FULLER B.S.

MEDICARE: MS. KELLI LYNNE FULLER B.S.
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 : 1831257989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLI LYNNE FULLER B.S.
Provider Business Mailing Address
First Line : 629 S 23RD ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47803-2541
Country : US
Telephone Number : 812-242-2534
Fax Number :
Provider Business Practice Location Address
First Line : 4600 S SPRINGHILL JCT
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47802-4584
Country : US
Telephone Number : 812-242-2244
Fax Number : 812-242-2210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/09/2007

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