Provider Demographics
NPI:1770817728
Name:MCCULLOUGH, JULIA A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:A
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3924
Mailing Address - Country:US
Mailing Address - Phone:913-544-1453
Mailing Address - Fax:
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 430
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-3230
Practice Address - Fax:913-541-3244
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74959-061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner