Healthcare Provider Details

I. General information

NPI: 1104589654
Provider Name (Legal Business Name): JULIA FITCHETT MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 FAIN RD
BLOUNTVILLE TN
37617-4616
US

IV. Provider business mailing address

296 FAIN RD
BLOUNTVILLE TN
37617-4616
US

V. Phone/Fax

Practice location:
  • Phone: 606-521-6069
  • Fax:
Mailing address:
  • Phone: 606-521-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28642
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180981
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number158271
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: