Healthcare Provider Details

I. General information

NPI: 1053581744
Provider Name (Legal Business Name): TERRELL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 EAST REELFOOT AVE SUITE 100
UNION CITY TN
38261
US

IV. Provider business mailing address

701 E REELFOOT AVE STE 100 PO BOX 398
UNION CITY TN
38261-5886
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-9687
  • Fax: 731-885-6643
Mailing address:
  • Phone: 731-885-9687
  • Fax: 731-885-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN92056
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN6675
License Number StateTN

VIII. Authorized Official

Name: RENEA L NAGEL-TERRELL
Title or Position: OWNER
Credential: CFNP-DNP
Phone: 731-885-9687