Provider Demographics
NPI:1902299787
Name:BELLA, KATHY (ARNP FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BELLA
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:DIAMONDVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:83116-0408
Mailing Address - Country:US
Mailing Address - Phone:307-800-8080
Mailing Address - Fax:307-800-8081
Practice Address - Street 1:71 FOSSIL DRIVE
Practice Address - Street 2:
Practice Address - City:DIAMONDVILLE
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-800-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY33582.1375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily