Provider Demographics
NPI:1922299072
Name:BRASHEAR, TERRINA ROMELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TERRINA
Middle Name:ROMELLE
Last Name:BRASHEAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W WASHBOURNE ST
Mailing Address - Street 2:P.O. BOX 350
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-4205
Mailing Address - Country:US
Mailing Address - Phone:918-253-4271
Mailing Address - Fax:918-253-2531
Practice Address - Street 1:1015 W WASHBOURNE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-4205
Practice Address - Country:US
Practice Address - Phone:918-253-4271
Practice Address - Fax:918-253-2531
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172822363LF0000X
ARA03020 ANP363LF0000X
OK73174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1922299072Medicaid
OK200127960AMedicaid
AR166818758Medicaid
AR5A586G180Medicare PIN