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General NPI Number Information
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NPI Number | 1780090167
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Entity Type | Individual
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Provider Name | JULIE ANN WALLS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 149 JERRY WEST HWY STE 2A
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City | LOGAN
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State | WV
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Zip | 25601-3967
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Country | US
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Telephone | 304-752-5100
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Fax | 304-250-3685
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | VERNER
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State | WV
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Zip | 25650-0145
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Country | US
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Telephone | 304-688-2373
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Fax | 304-250-3685
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN64382-NP-C
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License Number State | WV
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