MEDICARE: NICOLAS KEPA BELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1154814382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS KEPA BELL

Provider Business Mailing Address
First Line	:	2800 WINFIELD SCOTT RD
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 WINFIELD SCOTT RD
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7662
Country	:	US
Telephone Number	:	425-306-9783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	06/12/2018

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Directions to “ NICOLAS KEPA BELL ” Practice Location

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