Provider Demographics
NPI:1245821396
Name:BELL, BETTY W
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:W
Last Name:BELL
Suffix:
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:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-0424
Mailing Address - Country:US
Mailing Address - Phone:662-361-7149
Mailing Address - Fax:
Practice Address - Street 1:2939 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2274
Practice Address - Country:US
Practice Address - Phone:662-726-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST012680183700000X
MS562076163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No183700000XPharmacy Service ProvidersPharmacy Technician