| Fuller Diagnostics, Llc | |
|
2600 Denali St Suite 450 Anchorage AK 99503-2746 | |
| (907) 561-0552 | |
| (907) 561-0562 |
| Full Name | Fuller Diagnostics, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2600 Denali St, Anchorage, Alaska |
| Authorized Official Name and Position | Kristi H Fuller (OWNER/PARTNER) |
| Authorized Official Contact | 9075610552 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fuller Diagnostics, Llc Po Box 92303 Anchorage AK 99509-2303 Ph: (907) 561-0552 | Fuller Diagnostics, Llc 2600 Denali St Suite 450 Anchorage AK 99503-2746 Ph: (907) 561-0552 |
| NPI Number | 1326152711 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 03/22/2012 |
| Medicare PECOS PAC ID | 9931119542 |
|---|---|
| Medicare Enrollment ID | O20060426000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326152711 | NPI | - | NPPES |
| 441 | Other | AK | STATE LICENSE RICHARD FULLER |
| 1194029488 | Other | NPI KRISTA PEMBERTON LCSW | |
| PS8574 | Medicaid | AK | |
| PSG123 | Medicaid | AK | |
| 51470 | Other | AK | NATNL REG-KRISTI FULLER |
| 51478 | Other | AK | NATNL REG-RICHARD FULLER |
| 1700865029 | Other | AK | NPI KRISTI FULLER |
| 1022 | Other | AK | STATE LICENSE MAUREEN YOUNG |
| 1023 | Other | AK | STATE LICENSE KRISTA PEMBERTON |
| 1578572947 | Other | AK | NPI RICHARD FULLER |
| 1821392119 | Other | NPI MAUREEN YOUNG LCSW | |
| PS04411 | Medicaid | AK | |
| 436 | Other | AK | STATE LICENSE KRISTI FULLER |
| Provider Name | Richard D Fuller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578572947 PECOS PAC ID: 4385654995 Enrollment ID: I20061214000083 |
| Provider Name | Erica Coady |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366759003 PECOS PAC ID: 3678769387 Enrollment ID: I20120118000648 |
| Provider Name | Sandra M Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235570979 PECOS PAC ID: 8123256161 Enrollment ID: I20140120000732 |
| Provider Name | Christopher P Cavanaugh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184017055 PECOS PAC ID: 7517325988 Enrollment ID: I20230615003229 |
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