MEDICARE: JULIE T TRICE CRNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	658766	MS
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1-053065	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184626905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE T TRICE CRNP

Provider Business Mailing Address
First Line	:	3929 AIRPORT BLVD STE 1-206
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-2233
Country	:	US
Telephone Number	:	251-721-9649
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 SHAMROCK CT
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553
Country	:	US
Telephone Number	:	228-497-0690
Fax Number	:	228-497-1363

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/03/2020

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Directions to “ JULIE T TRICE CRNP” Practice Location

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