Jalisa Fuller
NPI 1982270088 · on the registry since 2021
Practice
- Address
- 1621 Williamsburg Dr
Bossier City, LA 71112 - Phone
- (318) 730-2368
Registry record
- Primary taxonomy
- Driver
172A00000X
- Licence states on file
- LA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2021-05-28
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Louisiana