Provider Demographics
NPI:1831101211
Name:ROYSTER, JULIE F (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:F
Last Name:ROYSTER
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:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:1660 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:LEDBETTER
Practice Address - State:KY
Practice Address - Zip Code:42058-9557
Practice Address - Country:US
Practice Address - Phone:270-898-1388
Practice Address - Fax:270-898-1389
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4010P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012176Medicaid
Q13820Medicare UPIN
KY78012176Medicaid