Healthcare Provider Details

I. General information

NPI: 1679712087
Provider Name (Legal Business Name): JULIANN PAIGE MATHENY FNP-C, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANN PAIGE STURM RN, APRN

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 LEADER AVE SUITE 119
LEXINGTON KY
40506-3446
US

IV. Provider business mailing address

138 LEADER AVE
LEXINGTON KY
40506-9983
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-7305
  • Fax:
Mailing address:
  • Phone: 502-693-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3011424
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011424
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: