1376648931 NPI number — JULIE LYNN STUART APRN, FNP-BC

Table of content: JULIE LYNN STUART APRN, FNP-BC (NPI 1376648931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376648931 NPI number — JULIE LYNN STUART APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUART
Provider First Name:
JULIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERENI
Provider Other First Name:
JULIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376648931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1208 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25526-8708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-757-5747
Provider Business Mailing Address Fax Number:
304-757-5744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526-8708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-757-5747
Provider Business Practice Location Address Fax Number:
304-757-5744
Provider Enumeration Date:
09/14/2006

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:  52366 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 78014222 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2687785 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810001874 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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