Provider Demographics
NPI:1710256540
Name:WELLS, JOHN KHARI (BA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KHARI
Last Name:WELLS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 W ALEXANDER RD
Mailing Address - Street 2:#38
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9081
Mailing Address - Country:US
Mailing Address - Phone:702-622-5150
Mailing Address - Fax:
Practice Address - Street 1:1237 W ALEXANDER RD
Practice Address - Street 2:#38
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9081
Practice Address - Country:US
Practice Address - Phone:702-622-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner