Provider Demographics
NPI:1104301522
Name:JOHNSON, JULIA ROSE (NP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E SAINT MAARTENS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2993
Mailing Address - Country:US
Mailing Address - Phone:816-232-0185
Mailing Address - Fax:
Practice Address - Street 1:802 N RIVERSIDE RD STE 220
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2509
Practice Address - Country:US
Practice Address - Phone:816-271-7074
Practice Address - Fax:816-271-6786
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017022220363L00000X
KS78353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily