Provider Demographics
NPI:1033790159
Name:FULLER, KAYLA LEANN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LEANN
Last Name:FULLER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 STATE HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:BERNIE
Mailing Address - State:MO
Mailing Address - Zip Code:63822-7215
Mailing Address - Country:US
Mailing Address - Phone:573-281-9637
Mailing Address - Fax:
Practice Address - Street 1:1207 N DOUGLASS ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MO
Practice Address - Zip Code:63863-1351
Practice Address - Country:US
Practice Address - Phone:573-276-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020018079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily