Provider Demographics
NPI:1619977584
Name:NAGEL-TERRELL, RENEA L (CFNP)
Entity Type:Individual
Prefix:
First Name:RENEA
Middle Name:L
Last Name:NAGEL-TERRELL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:RENEA
Other - Middle Name:NAGEL
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:701 E REELFOOT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5880
Mailing Address - Country:US
Mailing Address - Phone:731-885-9687
Mailing Address - Fax:731-885-6643
Practice Address - Street 1:701 E REELFOOT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5880
Practice Address - Country:US
Practice Address - Phone:731-885-9687
Practice Address - Fax:731-885-6643
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN92056363L00000X
TNAPN 6675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1504900Medicaid
TNP41828Medicare UPIN
TN1504900Medicaid