Healthcare Provider Details

I. General information

NPI: 1942286133
Provider Name (Legal Business Name): JAN ELLEN WELLS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N FAIRLAND ST SUITE 104
PRYOR OK
74361-4203
US

IV. Provider business mailing address

109 N FAIRLAND ST SUITE 104
PRYOR OK
74361-4203
US

V. Phone/Fax

Practice location:
  • Phone: 918-824-4424
  • Fax: 918-824-4474
Mailing address:
  • Phone: 918-824-4424
  • Fax: 918-824-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0027163
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: