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General NPI Number Information
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NPI Number | 1134374309
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Entity Type | Individual
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Provider Name | CHARLES ROBERT PURDY JR. RN
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Gender | Male
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 5667 MARK TRL
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City | HOUSE SPRINGS
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State | MO
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Zip | 63051-2240
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Country | US
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Telephone | 727-776-5948
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Fax |
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Provider Business Mailing Address
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Address Line | 5667 MARK TRL
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City | HOUSE SPRINGS
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State | MO
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Zip | 63051-2240
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Country | US
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Telephone | 727-776-5948
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R51609
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9245172
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 635760
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2003026652
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1104666
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License Number State | KY
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