Provider Demographics
NPI:1396831608
Name:WELLMAN, JENNIFER M (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:1 TIMBERWOLF DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-1764
Practice Address - Fax:304-429-1746
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07422363L00000X
KY3488P363L00000X
WV50871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV34876OtherLICENSE
KY78005741Medicaid
OH2282524Medicaid
WV7105076000Medicaid
KS3488POtherLICENSE
WVMW2749351OtherDEA
KS3488POtherLICENSE
OH2282524Medicaid
WV7105076000Medicaid
WVWV3498C729Medicare PIN
WVWV3498AMedicare PIN
WVWV3498C437Medicare PIN
WVWV3498C380Medicare PIN
WVMW2749351OtherDEA
WVWV3498C455Medicare PIN
WVWV3498C595Medicare PIN