MEDICARE: WELLSPRINGS INSTITUTE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		KY

General Provider Information

NPI Number	:	1588733661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRINGS INSTITUTE, PLLC

Provider Business Mailing Address
First Line	:	2721 W PARK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9058
Country	:	US
Telephone Number	:	270-554-7546
Fax Number	:	270-554-0316

Provider Business Practice Location Address
First Line	:	2721 W PARK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9058
Country	:	US
Telephone Number	:	270-554-7546
Fax Number	:	270-554-0316

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. LISA A BOYD
Credential	:
Telephone Number	:	270-554-7546

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/21/2022

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