Healthcare Provider Details

I. General information

NPI: 1518822741
Provider Name (Legal Business Name): JULIA NICOLE PAUL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 CLAYTON RD
SAINT LOUIS MO
63117-1811
US

IV. Provider business mailing address

5 GREENBRIAR LN
GLEN CARBON IL
62034-2908
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8360
  • Fax:
Mailing address:
  • Phone: 618-578-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: