Steven Edwin Reenan, LPC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Iberia, MO
NPI 1922052091 · NPPES record last updated May 29, 2012
Key facts
- NPI
- 1922052091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 2012004610 (MO)
- Practice address
- 986 Highway a
Iberia, MO 65486-8242 - Phone
- (573) 793-2162
- Fax
- (573) 793-2162
- NPI assigned
- May 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130118000266 | MO | Practitioner - Nurse Practitioner | 1052564267 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CS 001374 | MO | MD | Professional Counselor |
| 2012004610 | MO | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CS 001374 | MO | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 2012004610 | MO | Yes |
Addresses
Primary practice location
986 Highway a
Iberia, MO 65486-8242
Mailing address
986 Highway a
Iberia, MO 65486-8242
Phone (573) 793-2162
Other providers in Iberia, MO
- Brian Herzog
- Iberia R-V School District
- Lake Regional Health System
- Medley Pharmacy Inc.
- Kyle Nichols
- Gary N Thomsen
All providers in Iberia, MO · Psychiatric/Mental Health Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.