Healthcare Provider Details

I. General information

NPI: 1881784635
Provider Name (Legal Business Name): JULITTA J. SHIRLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SMITHSON DR. STE. A
CASSVILLE MO
65625-9429
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-847-3500
  • Fax: 417-847-3523
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number095274
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: