Healthcare Provider Details

I. General information

NPI: 1831838325
Provider Name (Legal Business Name): MS. JESSICA LYNN WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S MCNEILL ST
CARTHAGE NC
28327-8987
US

IV. Provider business mailing address

PO BOX 3387
MORGANTON NC
28680-3387
US

V. Phone/Fax

Practice location:
  • Phone: 910-852-9660
  • Fax: 828-639-8058
Mailing address:
  • Phone: 828-584-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017357
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: