Provider Demographics
NPI:1730471905
Name:MICHAEL, JULE ELLEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:JULE
Middle Name:ELLEN
Last Name:MICHAEL
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 1:2002 BROOKSIDE DR
Mailing Address - Street 2:STE 102
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4634
Mailing Address - Country:US
Mailing Address - Phone:423-245-6000
Mailing Address - Fax:423-245-4190
Practice Address - Street 1:2002 BROOKSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-245-6000
Practice Address - Fax:423-245-4190
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169320363LF0000X
TN156859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN15659OtherAPN