Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 436 | AK |
Y | 103TC0700X | Clinical Psychologist | 436 | AK |
N | 102L00000X | Psychologist | 436 | AK |
N | 103T00000X | Psychologist | 436 | AK |
N | 103TA0700X | Adult Development & Aging Psychologist | 436 | AK |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 436 | AK |
N | 103G00000X | Clinical Psychologist | 436 | AK |
N | 103TC0700X | Clinical Psychologist | 436 | AK |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 436 | AK |
N | 103TF0200X | Forensic Psychologist | 436 | AK |
N | 103TM1800X | Intellectual & Developmental Disabilities | 436 | AK |
NPI | 1700865029 |
---|---|
Provider Name | Dr. Kristi H Fuller |
First Address | Anchorage, AK 99509-2303 |
Second Address | Anchorage, AK 99503-2746 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 22/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203902391 | TRIWEST (01) | AK |
436 | STATE LICENSE (01) | AK |
5093431 | AETNA PIN (01) | AK |
51470 | NATIONAL REGISTER-PSYCHOL (01) | DC |
5905 | ABPP-CN (01) | AK |
PS8574 | (05) | AK |