Healthcare Provider Details

I. General information

NPI: 1497724264
Provider Name (Legal Business Name): TERRY G REESE MSN APRN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 N GRETNA RD BRANSON VA OUT PATIENT CLINIC
BRANSON MO
65616-7287
US

IV. Provider business mailing address

1440 STATE HIGHWAY 248 SUITE Q456
BRANSON MO
65616-9655
US

V. Phone/Fax

Practice location:
  • Phone: 417-243-2300
  • Fax: 417-243-2390
Mailing address:
  • Phone: 417-243-2300
  • Fax: 417-243-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number132076
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number132076
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number132076
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: