Provider Demographics
NPI:1083653257
Name:BELL, DEBRA E (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:E
Last Name:BELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:E
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9754
Mailing Address - Country:US
Mailing Address - Phone:601-624-8985
Mailing Address - Fax:
Practice Address - Street 1:248 E CAPITOL ST
Practice Address - Street 2:840 TRUST MARK BLDG
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-2503
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7509
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR778758163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00313838OtherRR MEDICARE PARADIGM
MS500002139Medicare ID - Type UnspecifiedMEDICARE PARADIGM
MSP00313838OtherRR MEDICARE PARADIGM
MS500001705Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER