Healthcare Provider Details

I. General information

NPI: 1619977584
Provider Name (Legal Business Name): RENEA L NAGEL-TERRELL CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEA NAGEL TERRELL CFNP

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E REELFOOT AVE SUITE 100
UNION CITY TN
38261-5880
US

IV. Provider business mailing address

701 E REELFOOT AVE SUITE 100
UNION CITY TN
38261-5880
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 TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN92056
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 6675
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: