Provider Demographics
NPI:1205420882
Name:FEDKE, JULIE ALDEN
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ALDEN
Last Name:FEDKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W GRAND PKWY S STE M
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8331
Mailing Address - Country:US
Mailing Address - Phone:281-916-1444
Mailing Address - Fax:
Practice Address - Street 1:1450 W GRAND PKWY S STE M
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8331
Practice Address - Country:US
Practice Address - Phone:281-916-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner