Provider Demographics
NPI:1790014520
Name:HAGGERTY, JULIE KAY (APN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KAY
Other - Last Name:KEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8985 E STATE HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61431-9542
Mailing Address - Country:US
Mailing Address - Phone:309-293-2605
Mailing Address - Fax:
Practice Address - Street 1:8985 E STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:IL
Practice Address - Zip Code:61431-9542
Practice Address - Country:US
Practice Address - Phone:309-293-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007867363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health