Julie Vang Broaddrick, FNP-C
Individual provider Active NPI Family Medicine Physician · Bixby, OK
NPI 1609463587 · NPPES record last updated Dec 28, 2020
Key facts
- NPI
- 1609463587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R0118511 (OK)
- Practice address
- 11911 S Memorial Dr
Bixby, OK 74008-2030 - Phone
- (918) 943-3790
- NPI assigned
- Dec 28, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
11911 S Memorial Dr
Bixby, OK 74008-2030
P O Box
Suite 334
Bixby, OK 74008-0334
Hospital & facility affiliations
- Ascension St John Jane Phillips
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Opted out of Medicare
- Yes, effective Oct 1, 2026 through Oct 1, 2028
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210201000400 | OK | Practitioner - Nurse Practitioner | 3072927110 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0118511 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 918 Family Wellness PLLC | Current |
Accepting new patients | |
| Prophylaxis Healthcare LLC | Current |
Accepting new patients | |
| Prophylaxis Healthcare LLC | Family Medicine | Current |
Accepting new patients |
| Jane Phillips Memorial Medical Center, Inc. | Past | Accepting new patients |
Locations
1407 SE Washington Blvd
Bartlesville, OK 74006
Phone (918) 335-2273
11911 S Memorial Dr
Bixby, OK 74008
Phone (918) 497-3700
8430 N 123rd East Ave
Owasso, OK 74055
Phone (918) 272-5755
12150 E 96th St N
Ste 101
Owasso, OK 74055
Phone (918) 716-5437
211 S Mill St
Pryor, OK 74361
Phone (918) 825-3777
303 E Taft Ave
Ste 3
Sapulpa, OK 74066
Phone (918) 224-2222
220 W 71st St
Ste 2
Tulsa, OK 74132
Phone (918) 584-8522
10802 E 31st St
Ste B
Tulsa, OK 74146
Phone (918) 970-2886
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R0118511 | OK | Yes |
Addresses
Primary practice location
11911 S Memorial Dr
Bixby, OK 74008-2030
Mailing address
PO Box 334
Bixby, OK 74008-0334
Phone (918) 943-3790
Other providers in Bixby, OK
- Brandi Brannon
- Dameko Brewer
- Brian S. Hicks D.C. Inc PC
- Bright Future Primary Care of Bixby
- Jacqueline Elane Briscoe
- Brookshire Grocery Company
- Michael T Brummert
- Brush Dentistry LLC
- Amber Dawn Burdette
- Stephanie Diane Burleson
All providers in Bixby, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.