Healthcare Provider Details

I. General information

NPI: 1982160859
Provider Name (Legal Business Name): JONATHAN WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W LOUDON AVE
LEXINGTON KY
40508-3729
US

IV. Provider business mailing address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-288-2425
  • Fax: 859-288-7510
Mailing address:
  • Phone: 859-288-2425
  • Fax: 859-288-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3013177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: