Provider Demographics
NPI:1982143855
Name:WELLS, SHERRY L (CST/CSFA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:WELLS
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 SPRING HOLLOW AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6371
Mailing Address - Country:US
Mailing Address - Phone:270-792-7255
Mailing Address - Fax:
Practice Address - Street 1:3260 SPRING HOLLOW AVE APT 1
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6371
Practice Address - Country:US
Practice Address - Phone:270-792-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA303246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant