Provider Demographics
NPI:1235243262
Name:WELLS, AMY (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WELLS
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 1:2305 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4691
Mailing Address - Country:US
Mailing Address - Phone:812-949-0405
Mailing Address - Fax:812-949-0445
Practice Address - Street 1:2305 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4691
Practice Address - Country:US
Practice Address - Phone:812-949-0405
Practice Address - Fax:812-949-0445
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000479A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10019630OtherBCBS
174143OtherHEALTH LINK
033353OtherHEALTH ALLIANCE
080075456OtherRAILROAD MEDICARE
148485OtherHEALTH LINK
043448OtherHEALTH ALLIANCE
336570Medicare ID - Type Unspecified
080075456OtherRAILROAD MEDICARE
E26544Medicare UPIN