Provider Demographics
NPI:1538326921
Name:TERRELL, BRIE BANULL (PA)
Entity Type:Individual
Prefix:MS
First Name:BRIE
Middle Name:BANULL
Last Name:TERRELL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:636-344-3701
Mailing Address - Fax:636-344-3100
Practice Address - Street 1:20 PROGRESS POINT PKWY
Practice Address - Street 2:DEPT ORTHOPAEDIC SURGERY, STE 114
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2206
Practice Address - Country:US
Practice Address - Phone:636-344-3701
Practice Address - Fax:636-344-3100
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012015998363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220029972Medicaid