Provider Demographics
NPI:1053330605
Name:WELLS, BEVERLY A (CNP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 DELAINE AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2706
Mailing Address - Country:US
Mailing Address - Phone:937-298-1341
Mailing Address - Fax:
Practice Address - Street 1:2314 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2802
Practice Address - Country:US
Practice Address - Phone:513-721-7635
Practice Address - Fax:513-721-2313
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03587363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2368441Medicaid