Diana Fuller,micou
Voluntary or Charitable in Kosciusko, MS. Individual provider (NPI-1).
NPI number1205348554
StatusActive
Last updated in NPPESSep 29, 2026
Details
- NPI
- 1205348554
- Entity type
- Individual (NPI-1)
- Name
- Diana Fuller,micou
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 26, 2017
- Last updated
- Sep 29, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251V00000X | Voluntary or Charitable | – | – | Yes |
Practice location
825 James H Meredith StKosciusko, MS 39090-3161
Phone 662-289-3699
Mailing address
825 James H Meredith StKosciusko, MS 39090-3161
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