Provider Demographics
NPI:1316733454
Name:WELLS, KOURTNEY
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:WELLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W WASHINGTON ST # 403
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4884
Mailing Address - Country:US
Mailing Address - Phone:240-527-2752
Mailing Address - Fax:
Practice Address - Street 1:32 W WASHINGTON ST # 403
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4884
Practice Address - Country:US
Practice Address - Phone:240-527-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant