Basic Information
| Provider Information | |||||||||
| NPI: | 1265820500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 HIGHWAY 62 W | ||||||||
| Address2: | |||||||||
| City: | ASH FLAT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725139415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709942202 | ||||||||
| FaxNumber: | 8709942328 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 HIGHWAY 62 W | ||||||||
| Address2: | |||||||||
| City: | ASH FLAT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725139415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709942202 | ||||||||
| FaxNumber: | 8079942328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2015 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A004268 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 308385758 | 05 | AR | MEDICAID |