Provider Demographics
NPI:1760016141
Name:LINK, JULIANNA CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:CHRISTINE
Last Name:LINK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 DIAMOND RDG STE 1200
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-7911
Mailing Address - Country:US
Mailing Address - Phone:573-632-5585
Mailing Address - Fax:
Practice Address - Street 1:1002 DIAMOND RDG STE 1200
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-7911
Practice Address - Country:US
Practice Address - Phone:573-632-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020000122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant