Provider Demographics
NPI:1295985273
Name:HUTT, JULIA TYE (CRNP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:TYE
Last Name:HUTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:TYE
Other - Last Name:VASSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:101 FITNESS WAY STE. 1200
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2492
Mailing Address - Country:US
Mailing Address - Phone:256-232-0636
Mailing Address - Fax:256-232-1281
Practice Address - Street 1:101 FITNESS WAY STE. 1200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2492
Practice Address - Country:US
Practice Address - Phone:256-232-0636
Practice Address - Fax:256-232-1281
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081164363LF0000X, 207Q00000X
ALMD.20182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL114656Medicaid
AL510-49763OtherBCBS
AL510-49766OtherBCBS
AL529917320Medicaid
AL51517535OtherBLUE CROSS BLUE SHIELD
AL114651Medicaid
AL114655Medicaid
AL114650Medicaid
AL114652Medicaid
AL510-49764OtherBCBS
AL515-99966OtherBCBS
AL510-49765OtherBCBS