Healthcare Provider Details

I. General information

NPI: 1760470918
Provider Name (Legal Business Name): JULIA E ECKARDT RN BC FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA E KIMMIS

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 JEFFERSON ST SUITE 120
WASHINGTON MO
63090-6449
US

IV. Provider business mailing address

12855 N 40 DR SUITE 200
SAINT LOUIS MO
63141-8635
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-4114
  • Fax: 636-390-8685
Mailing address:
  • Phone: 314-628-1210
  • Fax: 314-628-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: