Provider Demographics
NPI:1235513508
Name:DUNN, JULIA PAIGE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:PAIGE
Last Name:DUNN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-246-7922
Mailing Address - Fax:423-246-4248
Practice Address - Street 1:737 E SEVIER AVE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4912
Practice Address - Country:US
Practice Address - Phone:423-246-7922
Practice Address - Fax:423-246-4248
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172562363LF0000X
TN19824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235513508Medicaid
TNQ015499Medicaid
VAVVI324AMedicare PIN