Provider Demographics
NPI:1366273104
Name:WELLS, SARA JO (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JO
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JO
Other - Last Name:HUNLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16850 STATE HIGHWAY 58 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-5259
Mailing Address - Country:US
Mailing Address - Phone:423-334-2300
Mailing Address - Fax:423-205-8410
Practice Address - Street 1:16850 STATE HIGHWAY 58 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-5259
Practice Address - Country:US
Practice Address - Phone:423-334-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN238476163W00000X
TN36543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse