Provider Demographics
NPI:1689796716
Name:WELLS, SHELLEY ROSE (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ROSE
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN,BC
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 2087
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-2087
Mailing Address - Country:US
Mailing Address - Phone:864-716-7750
Mailing Address - Fax:864-716-7759
Practice Address - Street 1:1655 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2062
Practice Address - Country:US
Practice Address - Phone:864-716-7750
Practice Address - Fax:864-716-7759
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2801207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1465Medicaid
SCNP1465Medicaid