Healthcare Provider Details

I. General information

NPI: 1770133761
Provider Name (Legal Business Name): TERI WELLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 03/20/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S GARNETT RD
TULSA OK
74129-5101
US

IV. Provider business mailing address

6179 S BALSAM WAY STE 110
LITTLETON CO
80123-3092
US

V. Phone/Fax

Practice location:
  • Phone: 918-665-1520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5511
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: