Provider Demographics
NPI:1356983282
Name:OUKO, JULIA KERUBO
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KERUBO
Last Name:OUKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BROADWAY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2324
Mailing Address - Country:US
Mailing Address - Phone:316-518-9577
Mailing Address - Fax:
Practice Address - Street 1:200 N BROADWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2324
Practice Address - Country:US
Practice Address - Phone:316-518-9577
Practice Address - Fax:316-746-2276
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79048-011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health