Individual
TERRELL MCCOLLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1369 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3313
(573) 772-7937
Mailing address
2558 BROWNWOOD CT, POPLAR BLUFF, MO 63901-2656
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2013036154
MO
Other
Enumeration date
10/31/2014
Last updated
10/31/2014
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