Provider Demographics
NPI:1740020767
Name:MCINTOSH, JULIE ANN (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 RIVER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-8389
Mailing Address - Country:US
Mailing Address - Phone:662-594-5088
Mailing Address - Fax:
Practice Address - Street 1:144 S THOMAS ST STE 202
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5337
Practice Address - Country:US
Practice Address - Phone:662-269-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905046363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care