Provider Demographics
NPI:1851316962
Name:BELL, BERNITA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BERNITA
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4904
Mailing Address - Country:US
Mailing Address - Phone:573-803-1771
Mailing Address - Fax:573-303-5861
Practice Address - Street 1:36 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4904
Practice Address - Country:US
Practice Address - Phone:573-803-1771
Practice Address - Fax:573-303-5861
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004199363LF0000X
MO102112364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL742975504001Medicaid
IL742975504001Medicaid
IL148928Medicare Oscar/Certification