Provider Demographics
NPI:1780787937
Name:BUOL, TERESA R (RN, MSN, RNFA, FNP-C)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:BUOL
Suffix:
Gender:F
Credentials:RN, MSN, RNFA, FNP-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:R
Other - Last Name:SEXE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, RNFA
Mailing Address - Street 1:147 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KAISER
Mailing Address - State:MO
Mailing Address - Zip Code:65047-2021
Mailing Address - Country:US
Mailing Address - Phone:573-280-8382
Mailing Address - Fax:
Practice Address - Street 1:1029 NICHOLS RD STE 401
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-302-3111
Practice Address - Fax:573-302-2869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014226163WR0006X
MO2015019127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
336152OtherAORN
050032OtherCNOR
RNFAOtherRN FIRST ASSISTANT