Provider Demographics
NPI:1164830543
Name:HORTON, JULIE D (NP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:D
Last Name:HORTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6828 AUTUMN LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2551
Mailing Address - Country:US
Mailing Address - Phone:423-314-1440
Mailing Address - Fax:
Practice Address - Street 1:3739 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3520
Practice Address - Country:US
Practice Address - Phone:423-875-0999
Practice Address - Fax:423-875-0896
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134169363LF0000X
GA218942363LF0000X
TN18956363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2819Medicaid
SCP01698288OtherRAILROAD MEDICARE
NCNCQ785C2342423AMedicare PIN
SCP01698288OtherRAILROAD MEDICARE
SCSC39336067Medicare PIN