Provider Demographics
NPI:1407022734
Name:KO, JULIE ALLISON WATSON (APN)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ALLISON WATSON
Last Name:KO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6968
Mailing Address - Country:US
Mailing Address - Phone:479-857-0763
Mailing Address - Fax:
Practice Address - Street 1:3600 CANTRELL RD STE 205
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-1892
Practice Address - Country:US
Practice Address - Phone:501-526-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01945363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics