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NPI Code Detail

MEDICARE: JULIET CLUTTER PA-C

MEDICARE: JULIET CLUTTER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0110006914VA
2363A00000XPhysician AssistantPATEMPTX
3363A00000XPhysician AssistantPA15760TX

General Provider Information

NPI Number : 1033751201
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIET CLUTTER PA-C
Provider Business Mailing Address
First Line : 8417 TRICKHAM BND
Second Line :
City : FORT WORTH
State : TX
Zip : 76131-1169
Country : US
Telephone Number : 402-960-7077
Fax Number :
Provider Business Practice Location Address
First Line : 7630 N BEACH ST STE 140
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-3016
Country : US
Telephone Number : 817-281-2977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2019
Last Update Date : 06/07/2023

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Directions to “ JULIET CLUTTER PA-C” Practice Location

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