Provider Demographics
NPI:1437454329
Name:PATTY, JULIE WHITLEY
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:WHITLEY
Last Name:PATTY
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 1:2960 KIMBERLIE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5331
Mailing Address - Country:US
Mailing Address - Phone:907-301-5589
Mailing Address - Fax:907-770-4982
Practice Address - Street 1:2960 KIMBERLIE CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5331
Practice Address - Country:US
Practice Address - Phone:907-301-5589
Practice Address - Fax:907-770-4982
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK948326171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator