Provider Demographics
NPI:1740407238
Name:COON, JULIE RAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RAY
Last Name:COON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1133
Mailing Address - Country:US
Mailing Address - Phone:304-927-5395
Mailing Address - Fax:
Practice Address - Street 1:227 CLAY RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-6906
Practice Address - Country:US
Practice Address - Phone:304-927-5200
Practice Address - Fax:304-927-5201
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27027164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse