Basic Information
Provider Information | |||||||||
NPI: | 1255712345 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BELL | ||||||||
FirstName: | TERESA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN, FNP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1210 KY HIGHWAY 36 E | ||||||||
Address2: | SUITE G3 | ||||||||
City: | CYNTHIANA | ||||||||
State: | KY | ||||||||
PostalCode: | 410317490 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8592353638 | ||||||||
FaxNumber: | 8592353536 | ||||||||
Practice Location | |||||||||
Address1: | 805 US HIGHWAY 27 S | ||||||||
Address2: |   | ||||||||
City: | CYNTHIANA | ||||||||
State: | KY | ||||||||
PostalCode: | 410316888 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8592341141 | ||||||||
FaxNumber: | 8592344244 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2015 | ||||||||
LastUpdateDate: | 11/14/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3009432 | KY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 7100364930 | 05 | KY |   | MEDICAID | 3009432 | 01 | KY | MEDICAL LICENSE | OTHER |