Healthcare Provider Details

I. General information

NPI: 1134254204
Provider Name (Legal Business Name): JULIE G ROBERTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BLOUNTVILLE BYP
BLOUNTVILLE TN
37617-0630
US

IV. Provider business mailing address

PO BOX 630
BLOUNTVILLE TN
37617-0630
US

V. Phone/Fax

Practice location:
  • Phone: 423-279-2777
  • Fax: 423-279-2797
Mailing address:
  • Phone: 423-279-2777
  • Fax: 423-279-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000119865
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: