MEDICARE: JULIE MOUTON NP

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	363LF0000X	Family Nurse Practitioner	NP-990226	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160580	OTHER	CO	STATE LICENSE
2	NP-990226	OTHER	CO	NURSE PRACTITIONER

General Provider Information

NPI Number	:	1679852792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE MOUTON NP

Provider Business Mailing Address
First Line	:	2643 PATTERSON RD
Second Line	:	SUITE 605
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-1936
Country	:	US
Telephone Number	:	970-298-2482
Fax Number	:	970-298-1701

Provider Business Practice Location Address
First Line	:	2643 PATTERSON RD
Second Line	:	SUITE 605
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-1936
Country	:	US
Telephone Number	:	970-298-2482
Fax Number	:	970-298-1701

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

Provider Enumeration Date	:	08/07/2011
Last Update Date	:	11/15/2016

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Directions to “ JULIE MOUTON NP” Practice Location

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