Provider Demographics
NPI:1881784635
Name:SHIRLEY, JULITTA J (FNP)
Entity type:Individual
Prefix:
First Name:JULITTA
Middle Name:J
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:75 SMITHSON DR.
Practice Address - Street 2:STE. A
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-9429
Practice Address - Country:US
Practice Address - Phone:417-847-3500
Practice Address - Fax:417-847-3523
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
190895OtherBLUE CROSS OF MO
MO428772503Medicaid
P88679Medicare UPIN
MO428772503Medicaid