Provider Demographics
NPI:1538515192
Name:WELLS, SALINA RENEE
Entity Type:Individual
Prefix:MRS
First Name:SALINA
Middle Name:RENEE
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:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0686
Mailing Address - Country:US
Mailing Address - Phone:606-826-0257
Mailing Address - Fax:606-826-0206
Practice Address - Street 1:2135 HIGHWAY 1185
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-7968
Practice Address - Country:US
Practice Address - Phone:606-826-0257
Practice Address - Fax:606-826-0206
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist