Julie Vang Broaddrick, FNP-C
Family Medicine in Bixby, OK. Individual provider (NPI-1).
NPI number1609463587
StatusActive
Last updated in NPPESDec 28, 2020
Details
- NPI
- 1609463587
- Entity type
- Individual (NPI-1)
- Name
- Julie Vang Broaddrick
- Credential
- FNP-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 28, 2020
- Certification date
- Dec 28, 2020
- Last updated
- Dec 28, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- Medicare opt-out
- Oct 1, 2026 to Oct 1, 2028
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | R0118511 | OK | Yes |
Practice location
11911 S Memorial DrBixby, OK 74008-2030
Phone 918-943-3790
Mailing address
Po Box 334Bixby, OK 74008-0334
Phone 918-943-3790
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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