| Doctor Name: | CAROL J. RUSSELL |
| NPI Number: | 1124274857 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 083018 |
| Business Practice Address: | 815 N. Lincoln #g Monett, MO - 657081641 |
| Business Phone Number: | 4173541500 |
| Business Fax Number: | 4173541505 |
| Mailing Address: | 3800 S. National Ave, Ste. 540 SPRINGFIELD |
| State: | MO |
| Postal Code: | 658075209 |
| Phone Number: | 4173541500 |
| Fax Number: | 4173541505 |
| NPI Enumeration Date: | 08/13/2008 |
| NPI Last Update Date: | 01/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 083018 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |