=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548753148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE PERCEFULL APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2018
-----------------------------------------------------
Last Update Date | 04/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 D W MEREDITH RD
-----------------------------------------------------
City | MUNFORDVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42765-9315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-268-3028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 D W MEREDITH RD
-----------------------------------------------------
City | MUNFORDVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42765-9315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-268-3028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 3012394
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 3012394
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------