Healthcare Provider Details

I. General information

NPI: 1376447417
Provider Name (Legal Business Name): TARA K WELLS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 NORTHBROOK DR
SLOCOMB AL
36375-1501
US

IV. Provider business mailing address

191 NORTHBROOK DR
SLOCOMB AL
36375-1501
US

V. Phone/Fax

Practice location:
  • Phone: 334-661-6072
  • Fax:
Mailing address:
  • Phone: 334-661-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-166243
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: