Healthcare Provider Details

I. General information

NPI: 1326844077
Provider Name (Legal Business Name): JASMIN A BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 N 40TH ST
EAST SAINT LOUIS IL
62205-2168
US

IV. Provider business mailing address

513 EMILY DR
O FALLON IL
62269-1305
US

V. Phone/Fax

Practice location:
  • Phone: 618-477-4868
  • Fax:
Mailing address:
  • Phone: 618-477-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number041464838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: