Healthcare Provider Details

I. General information

NPI: 1245285139
Provider Name (Legal Business Name): CHARLENE B FURR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S SAM HOUSTON BLVD
HOUSTON MO
65483-2045
US

IV. Provider business mailing address

PO BOX 1359
AVA MO
65608-1359
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-0772
  • Fax: 417-683-6153
Mailing address:
  • Phone: 417-683-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019002853
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number069880
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: