NINO FULLER (AGACNP-BC) – Nurse Practitioner, NPI 1962974469
Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
22,204 NURSE PRACTITIONER in TX
Provider Addresses for NINO FULLER (AGACNP-BC)
23914 COUNTY ROAD 3313
CHANDLER, TX 75758
Phone: (607) 226-1012
Type: Mailing
300 WILSON ST
HENDERSON, TX 756525956
Phone: (903) 655-6536
Type: Mailing
PO BOX 742616
ATLANTA, GA 303742616
Phone: (770) 219-8420
Type: Mailing
743 SPRING ST NE
GAINESVILLE, GA 305013715
Phone: (770) 219-9000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-09-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190508001054 | I | Nurse Practitioner | TX | TBD |
| I20201216001434 | I | Nurse Practitioner | VA | TBD |
| I20210908000780 | I | Nurse Practitioner | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75758)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | TX | |
| Critical Care (Intensivists), Pulmonary Disease | TX | |
| Orthopedic Surgery | TX | |
| - | TX | |
| - | TX | |
| - | TX | |
| - | TX | |
| Internal Medicine | TX | |
| - | TX | |
| Physician Assistant | TX |
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