Healthcare Provider Details

I. General information

NPI: 1144749748
Provider Name (Legal Business Name): CHARNELL SUE ALLAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10627 LAWRENCE 1170
MOUNT VERNON MO
65712-8174
US

IV. Provider business mailing address

10627 LAWRENCE 1170
MOUNT VERNON MO
65712-8174
US

V. Phone/Fax

Practice location:
  • Phone: 417-818-0380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017033618
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: