Healthcare Provider Details

I. General information

NPI: 1144535030
Provider Name (Legal Business Name): JULIE K RUSSELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 COVERT AVE STE 101
EVANSVILLE IN
47714-5600
US

IV. Provider business mailing address

4770 COVERT AVE STE 101
EVANSVILLE IN
47714-5600
US

V. Phone/Fax

Practice location:
  • Phone: 812-848-2322
  • Fax:
Mailing address:
  • Phone: 812-842-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71003322A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: