Basic Information
| Provider Information | |||||||||
| NPI: | 1922193119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUELL-HARRIS | ||||||||
| FirstName: | SHIRLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 JOEL DRIVE | ||||||||
| Address2: | BLANCHFIELD ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FORT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988372 | ||||||||
| FaxNumber: | 2709560180 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 JOEL DRIVE | ||||||||
| Address2: | BLANCHFIELD ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FORT CAMPBELL | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422235349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707988372 | ||||||||
| FaxNumber: | 2709560180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 76877 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.