Healthcare Provider Details

I. General information

NPI: 1275041311
Provider Name (Legal Business Name): BRENDA ANN MCGEHEE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 2001
ELLSINORE MO
63937-9532
US

IV. Provider business mailing address

RR 2 BOX 2001
ELLSINORE MO
63937-9532
US

V. Phone/Fax

Practice location:
  • Phone: 573-429-7633
  • Fax:
Mailing address:
  • Phone: 573-429-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017034981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: