Healthcare Provider Details

I. General information

NPI: 1538573431
Provider Name (Legal Business Name): MRS. JESSICA GRAVELY BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRUSHY CREEK RD
EASLEY SC
29642-1120
US

IV. Provider business mailing address

115 BRUSHY CREEK RD
EASLEY SC
29642-1120
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-1633
  • Fax: 864-855-1323
Mailing address:
  • Phone: 864-635-0376
  • Fax: 864-442-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18876
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: