Provider Demographics
NPI:1194987362
Name:WELLS, DAVID KEVIN (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KEVIN
Last Name:WELLS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N 6TH ST # 786
Mailing Address - Street 2:
Mailing Address - City:EMERY
Mailing Address - State:SD
Mailing Address - Zip Code:57332-2124
Mailing Address - Country:US
Mailing Address - Phone:423-767-6130
Mailing Address - Fax:
Practice Address - Street 1:411 N 6TH ST # 786
Practice Address - Street 2:
Practice Address - City:EMERY
Practice Address - State:SD
Practice Address - Zip Code:57332-2124
Practice Address - Country:US
Practice Address - Phone:423-767-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR034284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse