Provider Demographics
NPI:1013408723
Name:WELLS, KAITLYN (CRNP)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 MOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2138
Mailing Address - Country:US
Mailing Address - Phone:334-315-5226
Mailing Address - Fax:
Practice Address - Street 1:6940 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3556
Practice Address - Country:US
Practice Address - Phone:334-279-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily