Provider Demographics
NPI:1710304902
Name:WELLS, LINDSAY (PA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 51ST ST APT 3201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-0004
Mailing Address - Country:US
Mailing Address - Phone:847-477-8906
Mailing Address - Fax:
Practice Address - Street 1:4407 BEE CAVES RD STE 512
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6496
Practice Address - Country:US
Practice Address - Phone:512-902-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14538363A00000X
IL227015833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist