Provider Demographics
NPI:1770830093
Name:FULLER, DARCI K
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:K
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 C AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4298
Mailing Address - Country:US
Mailing Address - Phone:641-672-3394
Mailing Address - Fax:641-672-3336
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-4298
Practice Address - Country:US
Practice Address - Phone:641-672-3394
Practice Address - Fax:641-672-3336
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA112463363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner