Provider Demographics
NPI:1467474627
Name:FULLER, CYNTHIA ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:FULLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:1025 MONTGOMERY HWY
Practice Address - Street 2:SUITE 211
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2805
Practice Address - Country:US
Practice Address - Phone:205-822-9544
Practice Address - Fax:205-822-9544
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-073898363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1467474627OtherUNITED BEHAVIORAL HEALTH
AL1467474627OtherMENTAL HEALTH NETWORK
AL51530421OtherBLUE CROSS #
AL1467474627OtherAMERICAN BEHAVIORAL
AL1467474627OtherBEHAVIORAL HEALTH SYSTEMS
AL1467474627OtherAMERICAN BEHAVIORAL
AL1467474627OtherUNITED BEHAVIORAL HEALTH