Provider Demographics
NPI:1619372240
Name:WHITWORTH, JULIE A (AGNP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:WHITWORTH
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Gender:F
Credentials:AGNP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8056
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-647-2098
Mailing Address - Fax:314-362-3192
Practice Address - Street 1:5225 MID AMERICA PLZ
Practice Address - Street 2:DIV IM MEDICAL ONCOLOGY, STE D115
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:800-647-2098
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2021-11-12
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Provider Licenses
StateLicense IDTaxonomies
MO2014036356363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420020044Medicaid