MR. KEVIN S FULLER (NPI# 1417119652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417119652 |
| Entity Type | Individual |
| Full Name | MR. KEVIN S FULLER |
| Credential | PA-C |
| Practice Address |
13135 Lee Jackson Memorial Hwy Ste 305 Fairfax VA 22033-1907 |
| Mailing Address |
13135 Lee Jackson Memorial Hwy Ste 305 Fairfax VA 22033-1909 |
| Practice Telephone | 7033598640 |
| Practice Fax Number | 7035916105 |
| Mailing Telephone | 7033598640 |
| Mailing Fax Number | 7035916105 |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2020-03-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0110001208 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 1417119652 | 05 | |
| VA | LICENSE NUMBER | 0110001208 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3620 Joseph Siewick Dr, Suite 406, Fairfax, VA 220331756 | 7033598640 | 7032596324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952833121 | Kevin Antonio Fuller | Counselor | 339 Magic Oaks Ct, Spring, TX 77388-8921 | 2017-03-28 |
| 1962737940 | Kevin Powell Fuller I | Home Health Aide | 1839 Zarker St, Harrisburg, PA 17104-1351 | 2009-10-09 |
| Street Address |
13135 LEE JACKSON MEMORIAL HWY STE 305 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22033-1907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417950981 | Timothy Roddy Shaver | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2005-05-27 |
| 1356816862 | Christopher A Reneau | Nurse Practitioner | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2018-10-11 |
| 1053764811 | Danielle Eganhouse | Physician Assistant | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1909 | 2016-07-18 |
| 1063856060 | Michael Grant Svestka | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2013-04-20 |
| 1295094233 | Matthew H Scriven | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2012-05-11 |
| 1932426095 | Yasmine Assadipour | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2010-04-29 |
| 1497994891 | Alison Karin Rude | Nurse Practitioner | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2009-02-10 |
| 1275794497 | George Younan | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2008-06-20 |
| 1912190430 | Enoch Marvin Sanders Jr. | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2007-08-20 |
| 1528039708 | Kathleen Marie Cleland | Surgery | 13135 Lee Jackson Memorial Hwy Ste 305, Fairfax, VA 22033-1907 | 2006-01-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366074320 | Han S Yoo | Pharmacist | 12200 West Ox Road, Fairfax, VA 22033 | 2020-02-07 |
| 1386137271 | Ammar Orthodontics Pllc | Dentist | 11702 Fiar Oaks Mall, Upper Floor, Fairfax, VA 22033 | 2018-06-14 |
| 1013360940 | Kellyn Patricia Dodd | Nurse Practitioner | 3903 Fair Ridge Dr Ste 209, Fairfax, VA 22033 | 2016-07-15 |
| 1659721363 | John Du Od PC | Optometrist | 12618 Victoria Station Ct, Fairfax, VA 22033 | 2016-06-14 |
| 1568861904 | Virginia Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 12734 Shoppes Lane, Fairfax, VA 22033 | 2014-08-21 |
| 1649696295 | Patrisha Lultschik | Nurse Practitioner | 12375 Lee Jackson Memorial Hwy, Fairfax, VA 22033 | 2014-03-06 |
| 1912321910 | Alyson Huber | Nurse Anesthetist, Certified Registered | 3600 Joseph Siewick Dr., Fairfax, VA 22033 | 2014-02-11 |
| 1578999314 | Aiatulah Surmaty | Optometrist | 11801 Lee Jackson Memorial Hwy, Fairfax, VA 22033 | 2013-09-25 |
| 1356780928 | Ayatallah M. Khafagy | Obstetrics & Gynecology | 3650 Joseph Siewick Dr Suite 203, Fairfax, VA 22033 | 2013-06-17 |
| 1760726665 | Michelle Elise Schwartz | Speech-Language Pathologist | 3507 Curtice Farm Dr, Fairfax, VA 22033 | 2012-11-15 |
| Find all providers in zip 22033 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053894493 | Natasha Olliver | Physician Assistant | 8500 Executive Park Ave Ste 200, Fairfax, VA 22031-2228 | 2018-09-12 |
| 1932681376 | Joanne Towers | Physician Assistant | 3025 Hamaker Court Suite 300, Fairfax, VA 22031 | 2018-09-01 |
| 1013493451 | Elizabeth Joan Dwyer | Physician Assistant | 3023 Hamaker Ct., Suite 500, Fairfax, VA 22031 | 2018-07-18 |
| 1831692375 | Lauren Mackenzie Mason | Physician Assistant | 3959 Pender Dr Ste 100, Fairfax, VA 22030-6041 | 2018-03-12 |
| 1164949665 | Kaitlyn Burns | Physician Assistant | 3700 Joseph Siewick Dr Ste 404, Fairfax, VA 22033-1745 | 2017-08-25 |
| 1699299628 | Mona Yazdani | Physician Assistant | 2920 District Ave Apt 359, Fairfax, VA 22031-4466 | 2017-08-01 |
| 1518396951 | Samantha Hancock | Physician Assistant | 10721 Main St Ste 200, Fairfax, VA 22030-6913 | 2013-11-06 |
| 1114263613 | Shoshana D Katz | Physician Assistant | 3031 Javier Rd Ste 210, Fairfax, VA 22031-4638 | 2013-01-02 |
| 1770610289 | Sonia J Mabout | Physician Assistant | 2812 Old Lee Hwy # 100b-d, Fairfax, VA 22031-4315 | 2007-02-28 |
| 1396705174 | Stephanie Anne Shepard | Physician Assistant | 2700 Prosperity Ave Ste 270, Fairfax, VA 22031-4321 | 2006-03-24 |
| Find all providers in FAIRFAX | ||||
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| 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.