Johnny Ray Fuller, LVN
Individual provider Active NPI Licensed Vocational Nurse · Center, TX
NPI 1306346184 · NPPES record last updated Feb 18, 2018
Key facts
- NPI
- 1306346184
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Vocational Nurse 164X00000X
- License
- 206588 (TX)
- Practice address
- 131 County Road 3102
Center, TX 75935-5581 - Phone
- (936) 591-9885
- NPI assigned
- Feb 18, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 206588 | TX | MD | Licensed Vocational Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 206588 | TX | Yes |
Addresses
Primary practice location
131 County Road 3102
Center, TX 75935-5581
Mailing address
364 County Road 1165
Center, TX 75935-6930
Phone (936) 332-3232
Other providers in Center, TX
- Tracee Fountain
- Fpacp Timpson LLC
- Carol Frame
- Shelley Marie Frame
- Michelle Franks
- Functional Rehabilitation Pediatrics, PLLC
- Functional Rehabilitation PLLC
- Gaddy Enterprises, Inc
- Wilda Dean Gardner
- Kyishia Garrett
All providers in Center, TX · Licensed Vocational Nurse in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2018. 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.