Individual
JULIA LYNNE RISLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5750 COVENTRY LN, SUITE 101, FORT WAYNE, IN 46804-7166
(260) 436-9337
(260) 436-9626
Mailing address
5750 COVENTRY LN, SUITE 101, FORT WAYNE, IN 46804-7166
(260) 436-9337
(260) 436-9626
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10000508A
IN
363AM0700X
Medical Physician Assistant
Primary
10000508A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000301921
ANTHEM
IN
Enumeration date
02/02/2006
Last updated
02/05/2024
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