Provider Demographics
NPI:1407311392
Name:BYRD, JULIA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ALEXANDRA
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HICKORY POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5009
Mailing Address - Country:US
Mailing Address - Phone:615-519-5649
Mailing Address - Fax:
Practice Address - Street 1:739 PRESIDENT PL STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6845
Practice Address - Country:US
Practice Address - Phone:615-625-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25323363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics