Provider Demographics
NPI:1922448968
Name:KREGER, JULIA MILLER
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MILLER
Last Name:KREGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ROSE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 M J ISRAEL DR
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3757
Mailing Address - Country:US
Mailing Address - Phone:985-281-2157
Mailing Address - Fax:985-545-1003
Practice Address - Street 1:100 M J ISRAEL DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3757
Practice Address - Country:US
Practice Address - Phone:985-281-2157
Practice Address - Fax:985-545-1003
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07183363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2348736Medicaid