Healthcare Provider Details

I. General information

NPI: 1619372240
Provider Name (Legal Business Name): JULIE A WHITWORTH AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 11/12/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 MID AMERICA PLZ DIV IM MEDICAL ONCOLOGY, STE D115
SAINT LOUIS MO
63129-0002
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8056
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 800-647-2098
  • Fax: 314-362-3192
Mailing address:
  • Phone: 800-647-2098
  • Fax: 314-362-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2014036356
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014036356
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: