Provider Demographics
NPI:1336416189
Name:STALEY, JULIA CHRISTINE (MSN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:CHRISTINE
Last Name:STALEY
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3528
Mailing Address - Country:US
Mailing Address - Phone:931-388-0203
Mailing Address - Fax:931-388-0205
Practice Address - Street 1:820 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3528
Practice Address - Country:US
Practice Address - Phone:931-388-0203
Practice Address - Fax:931-388-0205
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016294363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health