1366830705 NPI number — JULIA GULLEY APN

Table of content: JULIA GULLEY APN (NPI 1366830705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366830705 NPI number — JULIA GULLEY APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULLEY
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ISELI
Provider Other First Name:
JULIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366830705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 54136
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79453-4136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-771-1386
Provider Business Mailing Address Fax Number:
806-771-1388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3708 22ND PL
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-771-7412
Provider Business Practice Location Address Fax Number:
806-771-7414
Provider Enumeration Date:
01/08/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP126909 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)