=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841799376
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA MICHELLE MCKELLAR PNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2018
-----------------------------------------------------
Last Update Date | 02/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2213 MARTIN DR
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-6245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-471-2171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8621 CRESTVIEW DR
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76182-6110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-367-9357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AP132840
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------