MEDICARE: JULIE T MASSOTH 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	3010177	KY
2	363LF0000X	Family Nurse Practitioner	71006755A	IN

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	:	1730623604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE T MASSOTH NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 SAGAMORE PKWY W
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1501
Country	:	US
Telephone Number	:	812-996-0323
Fax Number	:	812-996-0321

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	06/02/2026

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