Provider Demographics
NPI:1386269629
Name:WELLS, MICHAELA CHEYENNE (NP-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:CHEYENNE
Last Name:WELLS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:12057 HIGHWAY 49 STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3177
Practice Address - Country:US
Practice Address - Phone:228-832-9385
Practice Address - Fax:877-504-6444
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903965163W00000X
MSWELL-FJ0DT3363L00000X
LA223744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner