Provider Demographics
NPI:1841799376
Name:MCKELLAR, JULIA MICHELLE (PNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MICHELLE
Last Name:MCKELLAR
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-6110
Mailing Address - Country:US
Mailing Address - Phone:940-367-9357
Mailing Address - Fax:
Practice Address - Street 1:2213 MARTIN DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6245
Practice Address - Country:US
Practice Address - Phone:817-471-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132840363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics