Individual
JULIE A LAMPLEY-DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4105 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 246-2910
(618) 246-2912
Mailing address
4105 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 246-2910
(618) 246-2912
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-002864
IL
363AS0400X
Surgical Physician Assistant
085002864
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3932056
BCBS GROUP NUMBER
IL
01
—
7210895
AETNA GROUP NUMBER
IL
Enumeration date
06/20/2007
Last updated
05/10/2019
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