Provider Demographics
NPI:1699808352
Name:WELLS, TONI LEIGH (PAC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:LEIGH
Last Name:WELLS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BASSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-1614
Mailing Address - Country:US
Mailing Address - Phone:214-681-5843
Mailing Address - Fax:
Practice Address - Street 1:3801 BASSWOOD LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-1614
Practice Address - Country:US
Practice Address - Phone:214-681-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L5195Medicare PIN
TX8K3475Medicare PIN