Basic Information
| Provider Information | |||||||||
| NPI: | 1275055337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | KATHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3032 E MOUNT MORRIS RD | ||||||||
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| City: | MOUNT MORRIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484588991 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 W 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485032445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102573736 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2017 | ||||||||
| LastUpdateDate: | 07/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 4704177636 | MI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.