Provider Demographics
NPI:1528098167
Name:BELLAH, JULIE K (PNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:BELLAH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:BELLAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP
Mailing Address - Street 1:1600 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-313-4200
Mailing Address - Fax:254-313-4326
Practice Address - Street 1:1600 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-2261
Practice Address - Country:US
Practice Address - Phone:254-313-4200
Practice Address - Fax:254-313-4326
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN055170163WP0200X
TX2173363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092245202OtherMEDICAID GRP # - THS
TX00N59XOtherBCBS GRP #
AZ120502Medicaid
TX00N59XOtherMEDICARE GRP #
TX084249401OtherMEDICAID GRP # - STANDARD