Healthcare Provider Details

I. General information

NPI: 1801240395
Provider Name (Legal Business Name): CLAUDE WILLIAM WELLS IV APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 CHURCH ST
STAMPS AR
71860-2816
US

IV. Provider business mailing address

218 CHURCH ST
STAMPS AR
71860-2816
US

V. Phone/Fax

Practice location:
  • Phone: 870-533-1300
  • Fax:
Mailing address:
  • Phone: 870-533-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004687
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: