Provider Demographics
NPI:1881919173
Name:WELLS, KYLE (RRT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-6001
Mailing Address - Country:US
Mailing Address - Phone:606-474-7939
Mailing Address - Fax:
Practice Address - Street 1:124 LITTLE RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6001
Practice Address - Country:US
Practice Address - Phone:606-474-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11048282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren