Provider Demographics
NPI:1437437464
Name:FULLER, COURTNEY CAROLE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:CAROLE
Last Name:FULLER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 COUNTY ROAD 6500
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-9557
Mailing Address - Country:US
Mailing Address - Phone:806-773-6575
Mailing Address - Fax:
Practice Address - Street 1:8104 COUNTY ROAD 6500
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-9557
Practice Address - Country:US
Practice Address - Phone:806-773-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671297163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)