Provider Demographics
NPI:1588687180
Name:WELLS, SHARON (APN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 APPLE MDWS
Mailing Address - Street 2:
Mailing Address - City:BETHEL HEIGHTS
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8312
Mailing Address - Country:US
Mailing Address - Phone:147-975-6316
Mailing Address - Fax:
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:147-944-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1465363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR17766Medicare UPIN