Provider Demographics
NPI:1033382684
Name:FURNISS-ROBERTS, JULIA LAVERNE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LAVERNE
Last Name:FURNISS-ROBERTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LION DR N
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-8621
Mailing Address - Country:US
Mailing Address - Phone:479-212-0951
Mailing Address - Fax:
Practice Address - Street 1:432 S 9TH STREET
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346
Practice Address - Country:US
Practice Address - Phone:918-253-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM0068281363LW0102X
ARA003077363LW0102X
OK68281363LW0102X
MSR751003363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR177023758Medicaid
OK200543710AMedicaid