Provider Demographics
NPI:1497708960
Name:BELT, JUNE (NP)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:
Last Name:BELT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1000 S BECKHAM AVE
Practice Address - Street 2:STE 101
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1908
Practice Address - Country:US
Practice Address - Phone:903-597-0351
Practice Address - Fax:903-592-5282
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
75-2616977-125OtherTRICARE
TX145580008Medicaid
TX145580003Medicaid
TXP01762469OtherRAIL ROAD MEDICARE
TX75-2616977-008OtherTRICARE
TX145580003Medicaid
TX145580008Medicaid
TX542895YMAFMedicare PIN