Provider Demographics
NPI:1255462735
Name:FULLER, DALE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DALE
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:6317 HARRIS PKWY
Practice Address - Street 2:STE.300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4256
Practice Address - Country:US
Practice Address - Phone:817-361-6900
Practice Address - Fax:817-522-1968
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32787Medicare UPIN
TX8237M2Medicare ID - Type Unspecified