Michael Fuller, LPN
Individual provider Active NPI Licensed Practical Nurse · Mayfield, KY
NPI 1013577667 · NPPES record last updated Jun 17, 2019
Key facts
- NPI
- 1013577667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- LPN0000092565 (TN)
- Practice address
- 1539 Cuba Rd
Mayfield, KY 42066-6809 - Phone
- (270) 251-2924
- NPI assigned
- Jun 17, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPN0000092565 | TN | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tncoviddefense | Current | Accepting new patients | |
| Western Ky Regional MHMR Board Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LPN0000092565 | TN | Yes |
Addresses
Primary practice location
1539 Cuba Rd
Mayfield, KY 42066-6809
Mailing address
425 Broadway St Ste 201
Paducah, KY 42001-0713
Phone (270) 442-7121
Other providers in Mayfield, KY
- Will Foston
- Four River Behavioral Health
- Freeman Dental
- Freeman Dental PLLC
- Bryan Douglas Freeman
- Fulton Home Care Services LLC
- Addison Futrell
- Jocelyn Gallagher
- Barbara Jean Gann
- Kayla Michelle Garrott
All providers in Mayfield, KY · Licensed Practical Nurse in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.