Provider Demographics
NPI:1629556980
Name:MCINTOSH, JULIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7531
Mailing Address - Country:US
Mailing Address - Phone:307-290-2891
Mailing Address - Fax:
Practice Address - Street 1:1690 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7531
Practice Address - Country:US
Practice Address - Phone:931-648-4838
Practice Address - Fax:931-919-0237
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012515363LF0000X
TN25311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3012515OtherFNP