Provider Demographics
NPI:1578963070
Name:BRINGLE, DOTTIE RENE
Entity Type:Individual
Prefix:
First Name:DOTTIE
Middle Name:RENE
Last Name:BRINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOTTIE
Other - Middle Name:RENE
Other - Last Name:BRINGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:15586 ACORN RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64840-6148
Mailing Address - Country:US
Mailing Address - Phone:417-825-1879
Mailing Address - Fax:
Practice Address - Street 1:198 FOUR STATES DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4304
Practice Address - Country:US
Practice Address - Phone:620-783-2356
Practice Address - Fax:620-783-2395
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014029919363LF0000X
KS53-76437-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily