Provider Demographics
NPI:1114228996
Name:WELLS, KRISTIE LYNN (LMT)
Entity Type:Individual
Prefix:MR
First Name:KRISTIE
Middle Name:LYNN
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 KEENE RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7751
Mailing Address - Country:US
Mailing Address - Phone:509-628-1805
Mailing Address - Fax:509-628-1805
Practice Address - Street 1:1950 KEENE RD
Practice Address - Street 2:SUITE P
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7751
Practice Address - Country:US
Practice Address - Phone:509-628-1805
Practice Address - Fax:509-628-1805
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60184375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist