Provider Demographics
NPI:1083619480
Name:GALLEY, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKBERRY
Mailing Address - State:LA
Mailing Address - Zip Code:70645-3303
Mailing Address - Country:US
Mailing Address - Phone:337-762-3762
Mailing Address - Fax:337-762-3838
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKBERRY
Practice Address - State:LA
Practice Address - Zip Code:70645-3303
Practice Address - Country:US
Practice Address - Phone:337-762-3762
Practice Address - Fax:337-762-3838
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1537730Medicaid
LA550398Medicare UPIN
LA1537730Medicaid