Andrea Nicole Fuller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10919 Issued in TX

Practice address

1411 Main St
Dallas, TX 75202-4052

Phone

(214) 749-4657

NPI assigned

Oct 11, 2016

Last updated

Jul 27, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1558811711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1985 CENTRAL EXPY N # 120",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750135753",
            "telephone_number": "972-962-9100",
            "fax_number": "512-782-9316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 MAIN ST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752024052",
            "telephone_number": "214-749-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ANDREA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-11",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pat Fox Fulgham, M.D.
• Dawn Maria Fulghum, LPTA
• Full Circle Counseling and Family Services, PLLC
• Full Life Outreach Medical Center LLC (Full Life Outreach Center)
• Aileen Fullchange, LP
• Dale Eugene Fuller, MD
• Dana A Fuller, MD
• Deborah A Fuller, M.D.
• Dwain Fuller, M.D. .
• Elise Fuller, COTA

• Physician Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.