Provider Demographics
NPI:1437147576
Name:CHILD, JULIE C (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:CHILD
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 1:1050 SOUTH MEDICAL DRIVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-538-1733
Mailing Address - Fax:435-538-1752
Practice Address - Street 1:1050 SOUTH MEDICAL DRIVE
Practice Address - Street 2:STE 101
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-538-1733
Practice Address - Fax:435-538-1752
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2167524405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT09709Medicaid
UT005193038Medicare ID - Type Unspecified
UTP01474Medicare UPIN