Provider Demographics
NPI:1427246230
Name:JULIAN, JUDY LYNN
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LYNN
Last Name:JULIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 W VANDERBILT ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-5601
Mailing Address - Country:US
Mailing Address - Phone:254-968-4799
Mailing Address - Fax:254-968-2795
Practice Address - Street 1:1060 W VANDERBILT ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-5601
Practice Address - Country:US
Practice Address - Phone:254-968-4799
Practice Address - Fax:254-968-2795
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120303310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility