KELLY FULLER


Address: 2020 Commerce Dr, Melbourne, FL 32904-2335
Phone: 3219526000

KELLY FULLER (NPI# 1144793407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1144793407
Entity Type Individual
Full Name KELLY FULLER
Credential APRN
Practice Address 2020 Commerce Dr
Melbourne
FL 32904-2335
Mailing Address 400 East Sheridan Rd
Melbourne
FL 32901
Practice Telephone 3219526000
Mailing Telephone 3217225200
Enumeration Date 2019-01-09
Last Update Date 2019-01-09
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
APRN1000259 FL Physician Assistants & Advanced Practice Nursing Providers

Other Providers KELLY FULLER

NPI Name Taxonomy Address Enumeration
1861964553 Kelly Anne Fuller Marriage & Family Therapist 850 E Foothill Blvd, Rialto, CA 92376-5230 2018-12-19
1871614115 Kelly Sue Fuller Counselor 1811 Sardis Rd N, Suite 207, Charlotte, NC 28270-1426 2007-04-03

Office Location

Street Address 2020 COMMERCE DR
City MELBOURNE
State FL
Zip Code 32904-2335

Providers in the same location

NPI Name Taxonomy Address Enumeration
1952741845 Stephanie Dean Fish Registered Nurse 2020 Commerce Dr, Melbourne, FL 32904-2335 2013-06-25
1164725933 Tanisha Campbell Licensed Practical Nurse 2020 Commerce Dr, Melbourne, FL 32904-2335 2010-12-16
1538362439 David Cyrus Ray Pharmacist 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-06-07
1023141033 Sheila Ponce Psychologist 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-03-13
1598807059 Sarah Tyler Social Worker 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-02-13
1245371160 James Braun Counselor 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-02-12
1285775122 Patti Diane Gibbons Counselor 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-02-12
1295876035 Harry Hillmer Counselor 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-02-12
1558402446 Mary Allen Counselor 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-02-12
1083755995 Joan Becker Counselor 2020 Commerce Dr, Melbourne, FL 32904-2335 2007-02-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1063066512 Shepherd's Heart Ministries Counselor 900 S Wickham Rd, Melbourne, FL 32904 2019-08-01
1588138663 Nicholle C Rothengass Physician Assistant 2263 W New Haven Ave # 350, W Melbourne, FL 32904 2019-01-11
1114407020 Natalie Havkin Speech-Language Pathologist 250 S Wickham Rd., Melbourne, FL 32904 2018-08-20
1184119299 Marni B Simon Speech-Language Pathologist 565 Acacia Ave, Melbourne Village, FL 32904 2018-06-30
1821588625 Walden Psychological Services, LLC Psychologist 3400 Willowwood Dr, Melbourne, FL 32904 2018-05-16
1598276271 Donetta Gwin Reynolds Early Intervention Provider Agency 764 Triples Crown Lane, West Melbourne, FL 32904 2017-10-20
1598205221 Marathon Health, LLC General Practice 2550 Wingate Boulevard, C/o Brevard Wellcare- South, West Melbourne, FL 32904 2017-02-28
1366875387 Cancer Center of Melbourne LLC Clinic/Center 415 S. Wickham Rd., Melbourne, FL 32904 2013-08-13
1558704312 Sandra Suzanne Borthwick Social Worker 569 Sylvia Rd, Melbourne, FL 32904 2013-04-11
1396983607 Genesis Skilled Nursing Facility 2653 Reflections Pl, W. Melbourne, FL 32904 2009-01-23
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1104304161 Nicolina Demuynck Nurse Practitioner 6767 N Wickham Rd Ste 306, Melbourne, FL 32940-2025 2018-08-01
1467771006 Terri Pesante Nurse Practitioner 400 E. Sheridan Rd, Melbourne, FL 32901 2010-05-21
1417583998 Thomas Smura Nurse Practitioner 400 East Sheridan Rd, Melbourne, FL 32901 2020-03-17
1306479399 Jessica Matos Nurse Practitioner 2120 Sarno Rd, Melbourne, FL 32935-3084 2020-02-18
1245453471 Mary Ann Barnett Nurse Practitioner 2340 Dairy Rd, Suite 104, Melbourne, FL 32904-5210 2007-04-10
1942364138 Karen Suzanne Berkley Nurse Practitioner 400 East Sheridan Rd, Melbourne, FL 32901-3122 2006-12-21
1790728616 Rebecca Biggin Nurse Practitioner 400 E Sheridan Rd, Melbourne, FL 32901-3122 2006-06-14
1568405090 Nancy Thompson Nurse Practitioner 400 E Sheridan Rd, Melbourne, FL 32901-3122 2006-06-13
1114960796 Mari Aldeghi Nurse Practitioner 400 E Sheridan Rd, Melbourne, FL 32901-3122 2006-06-13
1689611683 Helen Feldman Nurse Practitioner 400 E Sheridan Rd, Melbourne, FL 32901-3122 2006-05-31
Find all providers in MELBOURNE

Competitor

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City MELBOURNE
Zip Code 32904

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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