Provider Demographics
NPI:1093824815
Name:WELLS, COURTENAY A (RN, FWP)
Entity type:Individual
Prefix:
First Name:COURTENAY
Middle Name:A
Last Name:WELLS
Suffix:
Gender:
Credentials:RN, FWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:3806 AMELIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5772
Practice Address - Country:US
Practice Address - Phone:765-449-3900
Practice Address - Fax:765-449-3901
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAPN # 71002195363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200852860Medicaid
IN200852860Medicaid