Provider Demographics
NPI:1952985210
Name:FULLER, JEENA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JEENA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JEENA
Other - Middle Name:
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:420 1/2 PLEASANT HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 1/2 PLEASANT HOLLOW CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-1531
Practice Address - Country:US
Practice Address - Phone:970-531-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant