Provider Demographics
NPI:1851470496
Name:WELLS, CALLIE M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:M
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
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 1724
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-1724
Mailing Address - Country:US
Mailing Address - Phone:270-522-0898
Mailing Address - Fax:270-522-6647
Practice Address - Street 1:214 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9153
Practice Address - Country:US
Practice Address - Phone:270-522-0898
Practice Address - Fax:270-522-6647
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005147363LF0000X
KY5147P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100018290Medicaid
KYK157901Medicare PIN