Healthcare Provider Details

I. General information

NPI: 1033382684
Provider Name (Legal Business Name): JULIA LAVERNE FURNISS-ROBERTS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S 9TH STREET
JAY OK
74346
US

IV. Provider business mailing address

103 LION DR N
GRAVETTE AR
72736-8621
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-4511
  • Fax:
Mailing address:
  • Phone: 479-212-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberM0068281
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA003077
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number68281
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR751003
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: