Provider Demographics
NPI:1093707770
Name:HALL, JULIE ANN GARRARD (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN GARRARD
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:GARRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5501 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8513
Practice Address - Country:US
Practice Address - Phone:765-741-2957
Practice Address - Fax:765-747-3310
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001321A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488982Medicaid
INM122404065OtherMEDICARE PTAN
IN200374670Medicaid
INP02685396OtherRAILROAD PTAN
IN047930010Medicare PIN