Provider Demographics
NPI:1285916783
Name:BELL, JESSICA BLAIR (ANP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAIR
Last Name:BELL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:302 MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-6415
Practice Address - Country:US
Practice Address - Phone:910-227-2850
Practice Address - Fax:910-227-2847
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005323363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC220162OtherREGISTERED NURSE LICENSE
NC5005323OtherNURSE PRACTITIONER LICENSE
NCNC2211EMedicare PIN