MEDICARE: JULIE KRISTIN POMEROY

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	385HR2055X	Child Mental Illness Respite Care	1566178	AZ

General Provider Information

NPI Number	:	1922238617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE KRISTIN POMEROY

Provider Business Mailing Address
First Line	:	PO BOX 50010
Second Line	:
City	:	PARKS
State	:	AZ
Zip	:	86018
Country	:	US
Telephone Number	:	928-635-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	3224 NORTH GOVERNMENT PRAIRIE ROAD
Second Line	:
City	:	PARKS
State	:	AZ
Zip	:	86018-0010
Country	:	US
Telephone Number	:	928-635-4158
Fax Number	:

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

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	07/16/2009

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