=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245285139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLENE B FURR FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 02/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1340 S SAM HOUSTON BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65483-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-967-0772
-----------------------------------------------------
Fax | 417-683-6153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1359
-----------------------------------------------------
City | AVA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65608-1359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-683-4831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2019002853
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 069880
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------