Provider Demographics
NPI:1538108113
Name:BELL, KATHY NINA (NP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:NINA
Last Name:BELL
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 1:155 CALLE PORTAL
Mailing Address - Street 2:#300
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-458-8075
Mailing Address - Fax:520-458-0339
Practice Address - Street 1:198 S. CORONADO
Practice Address - Street 2:SUITE A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-8075
Practice Address - Fax:520-458-0339
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN068627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ325391Medicaid
325391001OtherMERCHCARE
272247OtherHEALTHNET
AZ325391Medicaid
325391001OtherMERCHCARE
S10529Medicare UPIN
AZZ105713Medicare PIN