Provider Demographics
NPI:1396387866
Name:BELLOWS, ELIZABETH NICHOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICHOLE
Last Name:BELLOWS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 WILLOW BEND DR W
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-8556
Mailing Address - Country:US
Mailing Address - Phone:817-739-1407
Mailing Address - Fax:
Practice Address - Street 1:2301 S FM 51 STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3864
Practice Address - Country:US
Practice Address - Phone:940-626-8810
Practice Address - Fax:940-626-8811
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143314363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TX8NH918OtherBCBSTX