Provider Demographics
NPI:1457091712
Name:CARRILLO, JULIE NGOZI (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:NGOZI
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2351
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-2351
Mailing Address - Country:US
Mailing Address - Phone:832-754-7287
Mailing Address - Fax:713-777-1747
Practice Address - Street 1:6500 HORNWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5095
Practice Address - Country:US
Practice Address - Phone:713-995-0909
Practice Address - Fax:713-777-1747
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2021184447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health