Provider Demographics
NPI:1609986280
Name:BELL, JAMIE LEA TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE LEA
Middle Name:TAYLOR
Last Name:BELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 4TH AVE
Mailing Address - Street 2:PO BOX 336
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-0336
Mailing Address - Country:US
Mailing Address - Phone:715-468-2711
Mailing Address - Fax:715-468-2727
Practice Address - Street 1:11134 N STATE ROAD 77
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5325
Practice Address - Country:US
Practice Address - Phone:715-634-5505
Practice Address - Fax:715-634-5558
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1334363A00000X
WI1334-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41924600Medicaid
P27303Medicare UPIN
WI001611055Medicare ID - Type Unspecified
WI41924600Medicaid
P27301Medicare UPIN