Provider Demographics
NPI:1982495487
Name:BELLVILLE, CASSIDY VICTORIA (APRN)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:VICTORIA
Last Name:BELLVILLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:VICTORIA
Other - Last Name:BELLVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:29 HIGH TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3518
Mailing Address - Country:US
Mailing Address - Phone:918-361-6113
Mailing Address - Fax:
Practice Address - Street 1:29 HIGH TRAILS DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3518
Practice Address - Country:US
Practice Address - Phone:918-361-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAG0520031363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology