Provider Demographics
NPI:1598704751
Name:KNAPP, JULIA R (FNP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:KNAPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:R
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-2151
Mailing Address - Country:US
Mailing Address - Phone:660-395-5045
Mailing Address - Fax:660-395-5048
Practice Address - Street 1:209 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2151
Practice Address - Country:US
Practice Address - Phone:660-395-5045
Practice Address - Fax:660-395-5048
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN117285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425827722Medicaid
MOP45572Medicare UPIN
MO425827722Medicaid