Provider Demographics
NPI:1285729970
Name:MEDLIN, JULIE D (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 S OUTER ROAD 364
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7756
Mailing Address - Country:US
Mailing Address - Phone:636-561-3277
Mailing Address - Fax:636-561-5280
Practice Address - Street 1:7136 S OUTER ROAD 364
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7756
Practice Address - Country:US
Practice Address - Phone:636-561-3277
Practice Address - Fax:636-561-5280
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146370363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical