Provider Demographics
NPI:1336612019
Name:KEALEY, JULIE-ANNE
Entity Type:Individual
Prefix:
First Name:JULIE-ANNE
Middle Name:
Last Name:KEALEY
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 1:3597 PROVINCE DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7803
Mailing Address - Country:US
Mailing Address - Phone:919-349-6258
Mailing Address - Fax:
Practice Address - Street 1:3597 PROVINCE DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7803
Practice Address - Country:US
Practice Address - Phone:919-349-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant