Provider Demographics
NPI:1982713764
Name:WHITESELL, JULIE C (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:WHITESELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 COMMONS DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2620
Mailing Address - Country:US
Mailing Address - Phone:307-426-4060
Mailing Address - Fax:307-426-4061
Practice Address - Street 1:7124 COMMONS DR UNIT C
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-2620
Practice Address - Country:US
Practice Address - Phone:307-426-4060
Practice Address - Fax:307-426-4061
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY337363AM0700X
COPA0002070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42526Medicare UPIN