Provider Demographics
NPI:1013722826
Name:WELLS, MELINDA ANN (OWNER)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CLARA FOOTE RD
Mailing Address - Street 2:
Mailing Address - City:BRAXTON
Mailing Address - State:MS
Mailing Address - Zip Code:39044-9708
Mailing Address - Country:US
Mailing Address - Phone:601-382-8585
Mailing Address - Fax:601-724-1199
Practice Address - Street 1:201 N COLLEGE ST STE 114
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3148
Practice Address - Country:US
Practice Address - Phone:601-724-1173
Practice Address - Fax:601-724-1199
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS327024163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty