Healthcare Provider Details

I. General information

NPI: 1851228043
Provider Name (Legal Business Name): JENNIFER STACY WELLS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE SECOND FLOOR WING D
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

740 S LIMESTONE SECOND FLOOR WING D
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-1676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number294932
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: