Provider Demographics
NPI:1740767417
Name:FOSSETT, JULIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:FOSSETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:PROF
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:FOSSETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:304 STONECREST LOOP
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-8234
Mailing Address - Country:US
Mailing Address - Phone:256-601-9032
Mailing Address - Fax:
Practice Address - Street 1:100 LANTANA RD STE 202
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-1903
Practice Address - Country:US
Practice Address - Phone:931-484-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ045998Medicaid