Provider Demographics
NPI:1467060988
Name:CROUCH, JULIE ELAINE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELAINE
Last Name:CROUCH
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 1:3713 BOBWHITE RD
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-7047
Mailing Address - Country:US
Mailing Address - Phone:903-235-9823
Mailing Address - Fax:
Practice Address - Street 1:3713 BOBWHITE RD
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-7047
Practice Address - Country:US
Practice Address - Phone:903-235-9823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92458164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse