Individual
MRS. JULIE ANN KUKURUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
154 S MAIN ST, TROUTMAN, NC 28166-0200
(704) 528-9903
(704) 528-4192
Mailing address
PO BOX 1845, STATESVILLE, NC 28687-1845
(704) 528-9903
(704) 528-4192
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001002803
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1017641
PA-CERTIFICATION
MI
01
—
5601001798
PA LICENSE
MI
Enumeration date
12/14/2006
Last updated
06/23/2015
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