Provider Demographics
NPI:1659674463
Name:BELL, JESSICA L (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 THERESA ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1636
Mailing Address - Country:US
Mailing Address - Phone:573-677-2006
Mailing Address - Fax:573-677-2068
Practice Address - Street 1:301 THERESA ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1636
Practice Address - Country:US
Practice Address - Phone:573-677-2006
Practice Address - Fax:573-677-2068
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021013364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01134653OtherRAILROAD MEDICARE
MOP01134653OtherRAILROAD MEDICARE