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Jalisa Fuller
Driver in Bossier City, Louisiana
NPI 1982270088

Jalisa Fuller is a Driver based in Bossier City, LA. Jalisa Fuller practices in Bossier City, LA. The NPI Number for Jalisa Fuller is 1982270088 and holds a License No. 009494849 (Louisiana).

The current practice location address for Jalisa Fuller is 1621 Williamsburg Dr, Bossier City, LA and can be reached out via phone at 318-730-2368.

Location: 1621 Williamsburg Dr, Bossier City, LA, 71112-3165
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1982270088
Provider Name
Jalisa Fuller
Credential
Provider Entity Type
Individual
Gender
Female
Address
1621 Williamsburg Dr, Bossier City, LA, 71112-3165
Phone Number
318-730-2368
Fax Number
Provider Enumeration Date
05/28/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
843382246 05 LA
institution
Provider Business Practice Location Address Details
Address
1621 Williamsburg Dr
City
Bossier City
State
Louisiana
Zip
71112-3165
Phone Number
318-730-2368
Fax Number
person
Provider Business Mailing Address Details
Address
1621 Williamsburg Dr
City
Bossier City
State
Louisiana
Zip
71112-3165
Phone Number
318-730-2368
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
172A00000X
License No.
009494849 (Louisiana)
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
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