Healthcare Provider Details

I. General information

NPI: 1003647439
Provider Name (Legal Business Name): JULIE MARIE STUBBLEFIELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3986
US

IV. Provider business mailing address

451 STONE CREST AVE
BOWLING GREEN KY
42101-8868
US

V. Phone/Fax

Practice location:
  • Phone: 270-535-2047
  • Fax:
Mailing address:
  • Phone: 270-535-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4062615
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: