Healthcare Provider Details

I. General information

NPI: 1851410393
Provider Name (Legal Business Name): JULIE LYNNETTE PURSIFULL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STONEWOOD LN
LEXINGTON KY
40509-4409
US

IV. Provider business mailing address

2315 STONEWOOD LN
LEXINGTON KY
40509-4409
US

V. Phone/Fax

Practice location:
  • Phone: 859-351-3062
  • Fax: 859-263-2649
Mailing address:
  • Phone: 859-351-3062
  • Fax: 859-263-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: