Provider Demographics
NPI:1104287044
Name:DORITY, JULIA AMILEE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:AMILEE
Last Name:DORITY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MCDOUGAL DR
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-2822
Mailing Address - Country:US
Mailing Address - Phone:405-379-4201
Mailing Address - Fax:405-379-4264
Practice Address - Street 1:100 MCDOUGAL DR
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-2822
Practice Address - Country:US
Practice Address - Phone:405-379-4201
Practice Address - Fax:405-379-4264
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0085717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily