Provider Demographics
NPI:1720483449
Name:WELLMAN, BRETT (NP-C)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-781-5159
Mailing Address - Fax:304-525-3338
Practice Address - Street 1:6350 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1232
Practice Address - Country:US
Practice Address - Phone:304-399-3350
Practice Address - Fax:304-697-2086
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV57267OtherWV LICENSE