Provider Demographics
NPI:1962818641
Name:BELL, KATHY X
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:BELL
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-8196
Mailing Address - Country:US
Mailing Address - Phone:417-664-3695
Mailing Address - Fax:417-924-8112
Practice Address - Street 1:113 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704-8196
Practice Address - Country:US
Practice Address - Phone:417-664-3695
Practice Address - Fax:417-924-8112
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO46352771400171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO46352771400Medicaid