Provider Demographics
NPI:1114561420
Name:NELSON, DEDEDRA BELLAMY (BSN, RN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:DEDEDRA
Middle Name:BELLAMY
Last Name:NELSON
Suffix:
Gender:F
Credentials:BSN, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4315
Mailing Address - Country:US
Mailing Address - Phone:901-567-3554
Mailing Address - Fax:901-567-3559
Practice Address - Street 1:2150 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6662
Practice Address - Country:US
Practice Address - Phone:901-354-7307
Practice Address - Fax:901-353-5464
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59687163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse