Provider Demographics
NPI:1477132660
Name:JULIAN, AMY SUSANNA (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUSANNA
Last Name:JULIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6276 E ROBERTS LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-8200
Mailing Address - Country:US
Mailing Address - Phone:417-866-6885
Mailing Address - Fax:
Practice Address - Street 1:6276 E ROBERTS LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-8200
Practice Address - Country:US
Practice Address - Phone:417-866-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70090363L00000X
MO2021017645363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty