Provider Demographics
NPI:1184802605
Name:UTLEY, JULIE B (PA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:UTLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:B
Other - Last Name:BEGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4805 E HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-8791
Mailing Address - Country:US
Mailing Address - Phone:405-381-9979
Mailing Address - Fax:405-381-9130
Practice Address - Street 1:4805 E HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-8791
Practice Address - Country:US
Practice Address - Phone:405-381-9979
Practice Address - Fax:405-381-9130
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200130350AMedicaid
OKOK400034Medicare PIN
OK200130350AMedicaid
OK5515260001Medicare NSC