Basic Information
| Provider Information | |||||||||
| NPI: | 1285916783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | BLAIR | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13815 PROFESSIONAL CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043162050 | ||||||||
| FaxNumber: | 7043162051 | ||||||||
| Practice Location | |||||||||
| Address1: | 13815 PROFESSIONAL CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043162050 | ||||||||
| FaxNumber: | 7043162051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2011 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5005323 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 220162 | 01 | NC | REGISTERED NURSE LICENSE | OTHER | 5005323 | 01 | NC | NURSE PRACTITIONER LICENSE | OTHER |