Healthcare Provider Details

I. General information

NPI: 1083653257
Provider Name (Legal Business Name): DEBRA E BELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA E BLACK

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 E CAPITOL ST 840 TRUST MARK BLDG
JACKSON MS
39201-2503
US

IV. Provider business mailing address

305 ROBINSON RD
CANTON MS
39046-9754
US

V. Phone/Fax

Practice location:
  • Phone: 800-632-6074
  • Fax: 866-341-7509
Mailing address:
  • Phone: 601-624-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR778758
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR778758
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: