Healthcare Provider Details

I. General information

NPI: 1376877381
Provider Name (Legal Business Name): JULIE K PHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE STE 3300
SPRINGFIELD MO
65804-2246
US

IV. Provider business mailing address

2115 S FREMONT AVE STE 3300
SPRINGFIELD MO
65804-2246
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-5200
  • Fax: 214-820-0993
Mailing address:
  • Phone: 417-820-5200
  • Fax: 214-820-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number732590
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2020024188
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: