Provider Demographics
NPI:1326573411
Name:WASHABAUGH, JULIE (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:WASHABAUGH
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:LONGFELLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5672 COUNTY ROAD 10 S
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9102
Mailing Address - Country:US
Mailing Address - Phone:719-496-6005
Mailing Address - Fax:
Practice Address - Street 1:1429 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2122
Practice Address - Country:US
Practice Address - Phone:719-496-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2024-08-26
Deactivation Date:2017-11-06
Deactivation Code:
Reactivation Date:2017-12-06
Provider Licenses
StateLicense IDTaxonomies
CORN.0200024163WP2201X
CORXN.0103012-NP363LF0000X
COF11170019363LF0000X
COAPN.0993569-NP363LF0000X
CO993569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily