Provider Demographics
NPI:1508842469
Name:WELLS, ROGER D (PA-C)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:WELLS
Suffix:
Gender:M
Credentials:PA-C
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 980
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-0980
Mailing Address - Country:US
Mailing Address - Phone:308-324-5651
Mailing Address - Fax:
Practice Address - Street 1:1201 N ERIE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1571
Practice Address - Country:US
Practice Address - Phone:308-324-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE70005753OtherRAILROAD MEDICARE
NE70005753OtherRAILROAD MEDICARE
NER81523Medicare UPIN