Provider Demographics
NPI:1336954536
Name:WELLS, CIKIETHIA (MT)
Entity type:Individual
Prefix:
First Name:CIKIETHIA
Middle Name:
Last Name:WELLS
Suffix:
Gender:U
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 BERKSHIRE DR NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1495
Mailing Address - Country:US
Mailing Address - Phone:252-205-0953
Mailing Address - Fax:
Practice Address - Street 1:3303 BERKSHIRE DR NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1495
Practice Address - Country:US
Practice Address - Phone:252-205-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist