Provider Demographics
NPI:1790769628
Name:RHODES, JULIE B (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:RHODES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 BELANGER ST
Mailing Address - Street 2:STE 102 104
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4463
Mailing Address - Country:US
Mailing Address - Phone:985-873-2961
Mailing Address - Fax:985-873-9074
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:STE 102 104
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-873-2961
Practice Address - Fax:985-873-9074
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAKN056387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432423Medicaid
LA1432423Medicaid
LA4B610Medicare ID - Type Unspecified