Provider Demographics
NPI:1457653727
Name:GUMPERT, JULIA ANNA LYN (PA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNA LYN
Last Name:GUMPERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANNA LYN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4610 SPRING HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9259
Mailing Address - Country:US
Mailing Address - Phone:910-973-2933
Mailing Address - Fax:
Practice Address - Street 1:4610 SPRING HILL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9259
Practice Address - Country:US
Practice Address - Phone:910-973-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02735363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical