Provider Demographics
NPI:1457016313
Name:BELLEVILLE, BREANNE PAIGE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BREANNE
Middle Name:PAIGE
Last Name:BELLEVILLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:PAIGE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:529 RYAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7578
Mailing Address - Country:US
Mailing Address - Phone:859-749-4655
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-6469
Practice Address - Fax:859-218-7585
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016977363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics