Provider Demographics
NPI:1245285139
Name:FURR, CHARLENE B (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:B
Last Name:FURR
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:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1359
Mailing Address - Country:US
Mailing Address - Phone:417-683-4831
Mailing Address - Fax:
Practice Address - Street 1:1340 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2045
Practice Address - Country:US
Practice Address - Phone:417-967-0772
Practice Address - Fax:417-683-6153
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002853363LF0000X
MO069880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO594000606OtherRH MEDICAID-NURSE PRACTIT
MO26-8526OtherRH MEDICARE-NURSE PRACTIT
MO428450001Medicaid
MO594000606OtherRH MEDICAID-NURSE PRACTIT
MO821283019Medicare ID - Type UnspecifiedNURSE PRACTITIONER