Provider Demographics
NPI:1497708135
Name:WELLS, KERMIT B (DPM)
Entity Type:Individual
Prefix:
First Name:KERMIT
Middle Name:B
Last Name:WELLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2655
Mailing Address - Country:US
Mailing Address - Phone:828-255-7879
Mailing Address - Fax:828-225-2755
Practice Address - Street 1:1056-C HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2655
Practice Address - Country:US
Practice Address - Phone:828-255-7879
Practice Address - Fax:828-225-2755
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU48186Medicare UPIN