Healthcare Provider Details

I. General information

NPI: 1780623942
Provider Name (Legal Business Name): JULIE ROSE LUCAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ROSE EDMOND PA-C

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S UNIVERSITY BLVD UCOM 6000 A
MOBILE AL
36688-0002
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5787
  • Fax: 251-660-5540
Mailing address:
  • Phone: 251-660-5787
  • Fax: 251-660-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-217
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: