Provider Demographics
NPI:1760470918
Name:ECKARDT, JULIA E (RN BC FNPC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:ECKARDT
Suffix:
Gender:F
Credentials:RN BC FNPC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:E
Other - Last Name:KIMMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8635
Mailing Address - Country:US
Mailing Address - Phone:314-628-1210
Mailing Address - Fax:314-628-1220
Practice Address - Street 1:1351 JEFFERSON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-6449
Practice Address - Country:US
Practice Address - Phone:636-390-4114
Practice Address - Fax:636-390-8685
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425899218Medicaid
MO000081318Medicare PIN
MOP00173044Medicare PIN
P66644Medicare UPIN
MO000081319Medicare PIN