Provider Demographics
NPI:1780119875
Name:GILLIAM, JULIE KAY (NP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KAY
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:390 DUCKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2039
Mailing Address - Country:US
Mailing Address - Phone:423-747-6211
Mailing Address - Fax:
Practice Address - Street 1:411 PRINCETON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2049
Practice Address - Country:US
Practice Address - Phone:423-461-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22506363L00000X
TNAPN0000022506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner