Healthcare Provider Details

I. General information

NPI: 1093405979
Provider Name (Legal Business Name): JULIE KAYLEEN WEBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 BELLEFONTAINE AVE STE 201
LIMA OH
45804-4803
US

IV. Provider business mailing address

967 BELLEFONTAINE AVE STE 201
LIMA OH
45804-4803
US

V. Phone/Fax

Practice location:
  • Phone: 419-301-3365
  • Fax: 419-909-0043
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.018801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: