Provider Demographics
NPI:1407344062
Name:WELLS, KALI ASHTON KAYE
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:ASHTON KAYE
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 NW MOTIF MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4828
Mailing Address - Country:US
Mailing Address - Phone:580-730-4049
Mailing Address - Fax:
Practice Address - Street 1:4733 NW MOTIF MANOR BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4828
Practice Address - Country:US
Practice Address - Phone:580-730-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator