Healthcare Provider Details

I. General information

NPI: 1255302410
Provider Name (Legal Business Name): JULIE ANN BLEVINS-SPRINKLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S MAIN ST
SPARTA NC
28675-9618
US

IV. Provider business mailing address

PO BOX 249
YADKINVILLE NC
27055-0249
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5911
  • Fax: 336-372-7394
Mailing address:
  • Phone: 336-679-4963
  • Fax: 336-679-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number127129
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number127129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: