Provider Demographics
NPI:1386033645
Name:WELLS, DAVENE (PA-C)
Entity type:Individual
Prefix:
First Name:DAVENE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAVENE
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 CENTERVIEW PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4289
Mailing Address - Country:US
Mailing Address - Phone:901-249-5905
Mailing Address - Fax:901-249-5940
Practice Address - Street 1:8000 CENTERVIEW PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4289
Practice Address - Country:US
Practice Address - Phone:901-249-5905
Practice Address - Fax:901-249-5940
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2684363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical