Provider Demographics
NPI:1285822643
Name:WELLS, LORI A (APRN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:HUTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-4459
Practice Address - Street 1:209 N MAYSVILLE ST STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1179
Practice Address - Country:US
Practice Address - Phone:859-404-7686
Practice Address - Fax:859-498-8160
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5353P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100021590Medicaid