Healthcare Provider Details

I. General information

NPI: 1235403619
Provider Name (Legal Business Name): JULIE KAY HEREFORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3400
  • Fax:
Mailing address:
  • Phone: 541-667-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250018NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: