Provider Demographics
NPI:1629046594
Name:WELLS, MAI T (PA-C)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:T
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2778 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8112
Mailing Address - Country:US
Mailing Address - Phone:316-631-1600
Mailing Address - Fax:316-631-1617
Practice Address - Street 1:2778 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8112
Practice Address - Country:US
Practice Address - Phone:316-631-1600
Practice Address - Fax:316-631-1617
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200353440AMedicaid
KS200353440AMedicaid
KS426886Medicare ID - Type Unspecified