Provider Demographics
NPI:1811668197
Name:OTT, JULIE FAIRCLOTH (FNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:FAIRCLOTH
Last Name:OTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 FOUR SEASONS BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2857
Mailing Address - Country:US
Mailing Address - Phone:828-693-4186
Mailing Address - Fax:
Practice Address - Street 1:3001 RICHARD B RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8657
Practice Address - Country:US
Practice Address - Phone:828-693-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017064363LF0000X, 363LF0000X
GARN198802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty