Provider Demographics
NPI:1447501143
Name:BELL, CATHERINE O (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:O
Last Name:BELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 DUTCHMANS LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4710
Mailing Address - Country:US
Mailing Address - Phone:502-897-1974
Mailing Address - Fax:502-897-3852
Practice Address - Street 1:4130 DUTCHMANS LN STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4710
Practice Address - Country:US
Practice Address - Phone:502-897-1794
Practice Address - Fax:502-897-3852
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001848B363A00000X
IN10001848A363A00000X
363AM0700X, 363AS0400X
KYPA1748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300011367Medicaid
KY7100226730Medicaid
ININ1920016Medicare PIN
KYK060490Medicare PIN