Provider Demographics
NPI:1275041311
Name:MCGEHEE, BRENDA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:MCGEHEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2001
Mailing Address - Street 2:
Mailing Address - City:ELLSINORE
Mailing Address - State:MO
Mailing Address - Zip Code:63937-9532
Mailing Address - Country:US
Mailing Address - Phone:573-429-7633
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2001
Practice Address - Street 2:
Practice Address - City:ELLSINORE
Practice Address - State:MO
Practice Address - Zip Code:63937-9532
Practice Address - Country:US
Practice Address - Phone:573-429-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017034981Medicaid