Healthcare Provider Details

I. General information

NPI: 1952025041
Provider Name (Legal Business Name): NICOLE MCKISSACK BELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MCKISSACK RN

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 09/11/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 E COLLEGE ST
DICKSON TN
37055-2032
US

IV. Provider business mailing address

1006 RED BIRD DR
CEDAR PARK TX
78613-5462
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-7016
  • Fax:
Mailing address:
  • Phone: 601-259-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242670
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: