Provider Demographics
NPI:1437272606
Name:WELLS, KELLY B (RPH DPH)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:B
Last Name:WELLS
Suffix:
Gender:F
Credentials:RPH DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 GOLFERS LANE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766
Mailing Address - Country:US
Mailing Address - Phone:423-871-1505
Mailing Address - Fax:
Practice Address - Street 1:502 WEST CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766
Practice Address - Country:US
Practice Address - Phone:423-562-3537
Practice Address - Fax:423-566-2212
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist