Provider Demographics
NPI:1316930647
Name:ISAAC, JULIE A (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:720 E SECOND AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1778
Mailing Address - Country:US
Mailing Address - Phone:270-843-5114
Mailing Address - Fax:270-745-1230
Practice Address - Street 1:720 E SECOND AVE
Practice Address - Street 2:SUITE 301 SOUTHERN KENTUCKY NEPHROLOGY ASSOCIATES
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1778
Practice Address - Country:US
Practice Address - Phone:270-843-5114
Practice Address - Fax:270-745-1230
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44132207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000809245AMedicaid
GA000809245AMedicaid
KY611318778OtherTIN#
GA000809245AMedicaid