Basic Information
| Provider Information | |||||||||
| NPI: | 1669880605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | CODY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 TAYLOR AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385554527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314846061 | ||||||||
| FaxNumber: | 9314846062 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 TAYLOR AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314846061 | ||||||||
| FaxNumber: | 9314846062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0000018907 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | Q007258 | 05 | TN | MEDICAID | 1669880605 | 01 | TN | NPI | OTHER | APN18907 | 01 | TN | ADVANCED PRACTICE NURSE | OTHER | RN01652213 | 01 | TN | RN | OTHER |