Provider Demographics
NPI:1508451055
Name:BELL, TAMARA SHANTRICE (NP)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:SHANTRICE
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 1:208 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-6768
Mailing Address - Country:US
Mailing Address - Phone:662-418-3565
Mailing Address - Fax:
Practice Address - Street 1:7474 HIGHWAY 45 ALT N
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-7981
Practice Address - Country:US
Practice Address - Phone:662-494-5863
Practice Address - Fax:662-494-5287
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS897722163W00000X
MS905612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse