Provider Demographics
NPI:1376902007
Name:STREET, JULIA (PA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:FELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 720006
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4006
Mailing Address - Country:US
Mailing Address - Phone:405-743-7300
Mailing Address - Fax:
Practice Address - Street 1:1201 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5476
Practice Address - Country:US
Practice Address - Phone:405-743-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant