Provider Demographics
NPI:1588669287
Name:BELL, TALLY N (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TALLY
Middle Name:N
Last Name:BELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 N COLLECTIVE LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3560
Mailing Address - Country:US
Mailing Address - Phone:316-261-3220
Mailing Address - Fax:316-261-3298
Practice Address - Street 1:2135 N COLLECTIVE LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3560
Practice Address - Country:US
Practice Address - Phone:316-261-3220
Practice Address - Fax:316-261-3298
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45294363LA2100X
KS14-39202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100358730BMedicaid
KS161548OtherMEDICARE
KS161548OtherMEDICARE