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General NPI Number Information
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NPI Number | 1992270995
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Entity Type | Organization
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Legal Business Name | JULIE K MARTIN, PMHNP-BC, LLC
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 1403 43RD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2545
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Country | US
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Telephone | 228-861-5240
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 43RD AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2545
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Country | US
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Telephone | 228-547-1945
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Fax |
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | JULIE MARTIN
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Credential | PMHNP-BC
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Telephone | 228-547-1945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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