MEDICARE: JULIA MARIA FUSTER 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
1	363AM0700X	Medical Physician Assistant	PA-1167	AR
2	363A00000X	Physician Assistant	0010-08253	NC

General Provider Information

NPI Number	:	1083190318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA MARIA FUSTER PA-C

Provider Business Mailing Address
First Line	:	199 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-3077
Country	:	US
Telephone Number	:	479-463-1001
Fax Number	:	479-463-1026

Provider Business Practice Location Address
First Line	:	199 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-3077
Country	:	US
Telephone Number	:	479-463-1001
Fax Number	:	479-463-1026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/26/2023

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