Provider Demographics
NPI:1578103982
Name:STOVER, JULIE RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RENEE
Last Name:STOVER
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 1:34124 CHOCTAW LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5261
Mailing Address - Country:US
Mailing Address - Phone:918-635-5180
Mailing Address - Fax:
Practice Address - Street 1:708 PIRATES WAY
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:AR
Practice Address - Zip Code:72932-9506
Practice Address - Country:US
Practice Address - Phone:479-471-1172
Practice Address - Fax:479-235-3025
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily