Healthcare Provider Details

I. General information

NPI: 1275960254
Provider Name (Legal Business Name): DEBORAH ANN HARRELL MSN,APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CREEKSIDE OFFICE DR
WENTZVILLE MO
63385-3289
US

IV. Provider business mailing address

105 CREEKSIDE OFFICE DR
WENTZVILLE MO
63385-3289
US

V. Phone/Fax

Practice location:
  • Phone: 636-639-6262
  • Fax:
Mailing address:
  • Phone: 636-639-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF0813261
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013030779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: