Provider Demographics
NPI:1053356410
Name:BELL, BLANCHE MAE (ARNP)
Entity type:Individual
Prefix:
First Name:BLANCHE
Middle Name:MAE
Last Name:BELL
Suffix:
Gender:F
Credentials:ARNP
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 70
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39121-0070
Mailing Address - Country:US
Mailing Address - Phone:225-433-3172
Mailing Address - Fax:601-228-4471
Practice Address - Street 1:4510 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-6016
Practice Address - Country:US
Practice Address - Phone:225-433-3172
Practice Address - Fax:601-228-4471
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1935242363LF0000X
MSR891765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009587564Medicaid
MS04450522Medicaid