| NPI | 1417368168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA R FULLER Owner 806-557-4138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP118557) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2022-03-02 |