Provider Demographics
NPI:1174817381
Name:SMALL, JULIE LYNNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNNE
Last Name:SMALL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:SPRADLIN
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 KIRKLEY CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-8597
Mailing Address - Country:US
Mailing Address - Phone:910-343-6890
Mailing Address - Fax:910-332-1233
Practice Address - Street 1:1606 PHYSICIANS DR STE 104
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7348
Practice Address - Country:US
Practice Address - Phone:910-343-6890
Practice Address - Fax:910-332-1233
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006814363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health