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General NPI Number Information
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NPI Number | 1376877381
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Entity Type | Individual
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Provider Name | JULIE K PHAM NP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 2115 S FREMONT AVE STE 3300
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2246
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Country | US
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Telephone | 417-820-5200
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Fax | 214-820-0993
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Provider Business Mailing Address
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Address Line | 2115 S FREMONT AVE STE 3300
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2246
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Country | US
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Telephone | 417-820-5200
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Fax | 214-820-0993
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 732590
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2020024188
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License Number State | MO
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