Healthcare Provider Details

I. General information

NPI: 1538764451
Provider Name (Legal Business Name): JULIE LAWRENCE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N GREEN ST
HENDERSON KY
42420-3109
US

IV. Provider business mailing address

230 N GREEN ST
HENDERSON KY
42420-3109
US

V. Phone/Fax

Practice location:
  • Phone: 270-854-3196
  • Fax:
Mailing address:
  • Phone: 270-854-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011041A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015466
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: