Provider Demographics
NPI:1851891352
Name:SHORT, JULIE CECILE (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CECILE
Last Name:SHORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:CECILE
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2202 S UPLAND HILLS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1066
Mailing Address - Country:US
Mailing Address - Phone:316-200-1183
Mailing Address - Fax:
Practice Address - Street 1:7348 W 21ST ST N STE 121
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1765
Practice Address - Country:US
Practice Address - Phone:316-722-0103
Practice Address - Fax:316-722-2333
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78060-042363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care