Provider Demographics
NPI:1205549524
Name:WELLS, WINTER ANGELINE (PA-C)
Entity type:Individual
Prefix:
First Name:WINTER
Middle Name:ANGELINE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 SE 74TH ST APT 5101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1131
Mailing Address - Country:US
Mailing Address - Phone:405-618-0360
Mailing Address - Fax:
Practice Address - Street 1:1800 E COPLIN ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-4642
Practice Address - Country:US
Practice Address - Phone:918-623-1424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant