Provider Demographics
NPI:1588898530
Name:WELLS, KIMBERLY JO (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 ALYSHEBA WAY, SUITE 150
Mailing Address - Street 2:MARSHALL EMERGENCY SERVICES ASSOCIATES
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1792 ALYSHEBA WAY, SUITE 150
Practice Address - Street 2:MARSHALL EMERGENCY SERVICES ASSOCIATES
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-335-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45439207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine