Provider Demographics
NPI:1891018370
Name:BLANCHARD, JULIA A (ANP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:ANP
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 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:1188 N SALEM RD
Practice Address - Street 2:SUITE 6
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8807
Practice Address - Country:US
Practice Address - Phone:479-442-0006
Practice Address - Fax:479-442-3038
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003337363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V014OtherAR BC/BS
AR185151758Medicaid
AR5V5266750Medicare PIN
AR5V526Medicare PIN