Provider Demographics
NPI:1669880605
Name:BELL, JUSTIN CODY (NP-C)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CODY
Last Name:BELL
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TAYLOR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4527
Mailing Address - Country:US
Mailing Address - Phone:931-484-6061
Mailing Address - Fax:931-484-6062
Practice Address - Street 1:29 TAYLOR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-484-6061
Practice Address - Fax:931-484-6062
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000018907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007258Medicaid
TN1669880605OtherNPI
TNAPN18907OtherADVANCED PRACTICE NURSE
TNRN01652213OtherRN