Provider Demographics
NPI:1457132490
Name:WELLS, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28827 JUTE RD
Mailing Address - Street 2:
Mailing Address - City:STARK CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64866-5500
Mailing Address - Country:US
Mailing Address - Phone:417-635-4667
Mailing Address - Fax:
Practice Address - Street 1:28827 JUTE RD
Practice Address - Street 2:
Practice Address - City:STARK CITY
Practice Address - State:MO
Practice Address - Zip Code:64866-5500
Practice Address - Country:US
Practice Address - Phone:417-635-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist