Provider Demographics
NPI:1871820159
Name:FULLWOOD, KAY FRANCES (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:FRANCES
Last Name:FULLWOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:FRANCES
Other - Last Name:FULLWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2345 LUANA DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9561
Mailing Address - Country:US
Mailing Address - Phone:904-641-3338
Mailing Address - Fax:904-646-4507
Practice Address - Street 1:2345 LUANA DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9561
Practice Address - Country:US
Practice Address - Phone:904-641-3338
Practice Address - Fax:904-646-4507
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP788522363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology