Provider Demographics
NPI:1992784086
Name:STAPP, JULIE ANN (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:STAPP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 SAINT JOHNS BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1563
Mailing Address - Country:US
Mailing Address - Phone:417-625-2300
Mailing Address - Fax:417-625-2005
Practice Address - Street 1:2817 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1563
Practice Address - Country:US
Practice Address - Phone:417-625-2300
Practice Address - Fax:417-625-2005
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428371603Medicaid
KS200267150BMedicaid
MO428371603Medicaid
MOMA2082076Medicare PIN