Dawn Fuller
Individual provider Active NPI Registered Nurse · Pine Bluff, AR
NPI 1679940951 · NPPES record last updated Aug 21, 2015
Key facts
- NPI
- 1679940951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R092355 (AR)
- Practice address
- 620 S Laurel St
Pine Bluff, AR 71601-4859 - Phone
- (870) 534-4900
- NPI assigned
- Aug 21, 2015
- Sex
- Female
- 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 |
|---|---|---|---|
| R092355 | AR | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R092355 | AR | Yes |
Addresses
Primary practice location
620 S Laurel St
Pine Bluff, AR 71601-4859
Mailing address
620 S Laurel St
Pine Bluff, AR 71601-4859
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180635526 | Medicaid | AR |
Other providers in Pine Bluff, AR
- Sade Anita Francois
- Philip Jay Mendez Frayre
- Shandra Freeman
- Jacquelyn Sue Frigon MD PA
- Ft McDonald DDS LTD
- Tia Fulton
- Madeline Noel Fults
- Functional Testing Centers, Inc.
- Snigdha Gadireddy
- Ian Trevor Gaillard
All providers in Pine Bluff, AR · Registered Nurse in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2015. 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.