Provider Demographics
NPI:1083190318
Name:FUSTER, JULIA MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIA
Last Name:FUSTER
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 1:199 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-3077
Mailing Address - Country:US
Mailing Address - Phone:479-463-1001
Mailing Address - Fax:479-463-1026
Practice Address - Street 1:199 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-3077
Practice Address - Country:US
Practice Address - Phone:479-463-1001
Practice Address - Fax:479-463-1026
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-1167363AM0700X
NC0010-08253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant