Basic Information
| Provider Information | |||||||||
| NPI: | 1225464787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDELL | ||||||||
| FirstName: | CAMMIE | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 BUFFALO TRL | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757030403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1903721079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4111 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757016623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032663400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2013 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 742151 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.