Provider Demographics
NPI:1427039023
Name:GEARHART, JULIE (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GEARHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N WABASH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2665
Mailing Address - Country:US
Mailing Address - Phone:765-662-4133
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:4781 S KAYBEE DR
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-6605
Practice Address - Country:US
Practice Address - Phone:765-998-9975
Practice Address - Fax:765-998-9979
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28096928A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health