Provider Demographics
NPI:1912255811
Name:OWEN, JULIE (PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 9TH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-3300
Mailing Address - Country:US
Mailing Address - Phone:806-744-0566
Mailing Address - Fax:806-744-7252
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-744-0566
Practice Address - Fax:806-744-7252
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant