Provider Demographics
NPI:1912414384
Name:CLARKE, JULIE ANN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9248
Mailing Address - Country:US
Mailing Address - Phone:503-999-2634
Mailing Address - Fax:
Practice Address - Street 1:5856 BIRCH DR
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9248
Practice Address - Country:US
Practice Address - Phone:503-999-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ267045363LF0000X
OR201709775NP207Q00000X, 363LF0000X
FL11015286363LF0000X
WA60825540363LF0000X
WAAP60825540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine