Provider Demographics
NPI:1427262377
Name:BELL, COSETTE ODOM (ARNP)
Entity type:Individual
Prefix:MRS
First Name:COSETTE
Middle Name:ODOM
Last Name:BELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:REBA
Other - Middle Name:COSETTE
Other - Last Name:ODOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 HARRIS TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-5052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1523 OLD VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-7132
Practice Address - Country:US
Practice Address - Phone:877-755-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9221343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308398500Medicaid