Provider Demographics
NPI:1891808838
Name:WELLS, KIERSTEN ANNE MACLEOD (CPNP)
Entity Type:Individual
Prefix:MS
First Name:KIERSTEN
Middle Name:ANNE MACLEOD
Last Name:WELLS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DUNCANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3145
Mailing Address - Country:US
Mailing Address - Phone:408-626-9931
Mailing Address - Fax:
Practice Address - Street 1:701 DUNCANVILLE CT
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3145
Practice Address - Country:US
Practice Address - Phone:408-626-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 12830363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics