Provider Demographics
NPI:1376648931
Name:STUART, JULIE LYNN (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:STUART
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:SERENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:1208 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8708
Mailing Address - Country:US
Mailing Address - Phone:304-757-5747
Mailing Address - Fax:304-757-5744
Practice Address - Street 1:1208 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8708
Practice Address - Country:US
Practice Address - Phone:304-757-5747
Practice Address - Fax:304-757-5744
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52366363L00000X, 363L00000X
KY30004395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014222Medicaid
OH2687785Medicaid
WV3810001874Medicaid
KY78014222Medicaid
OH2687785Medicaid
KYP00236239Medicare PIN
Q38789Medicare UPIN
WV3810001874Medicaid