CARLY FAITH FULLER NPI 1295293611

NPI Information

  • NPI: 1295293611
  • Provider Name: CARLY FAITH FULLER
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2300 OPITZ BLVD
    WOODBRIDGE, VA
    ZIP 22191
  • Phone: (703) 915-5550

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NPI Details

Carly Faith Fuller is a medical physician assistant in Woodbridge, VA with 6 years of experience. Carly Faith Fuller NPI is 1295293611. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2300 OPITZ BLVD
WOODBRIDGE, VA
ZIP 22191-311
Phone: (703) 915-5550

The NPI 1295293611 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/5/2019 and was last updated on 12/29/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant0110007223VIRGINIANo
2363AM0700XPhysician AssistantMedical0110007223VIRGINIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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