Provider Demographics
NPI:1073725883
Name:NIMS, RENA
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:NIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-0166
Mailing Address - Country:US
Mailing Address - Phone:417-582-5952
Mailing Address - Fax:417-582-5960
Practice Address - Street 1:304 N 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-0166
Practice Address - Country:US
Practice Address - Phone:417-582-5952
Practice Address - Fax:417-582-5960
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO466206901Medicaid