Healthcare Provider Details

I. General information

NPI: 1194573295
Provider Name (Legal Business Name): LAUREN WELLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 OLD AIRPORT RD
MOAB UT
84532-5102
US

IV. Provider business mailing address

5555 OLD AIRPORT RD
MOAB UT
84532-5102
US

V. Phone/Fax

Practice location:
  • Phone: 435-419-9210
  • Fax: 435-216-3020
Mailing address:
  • Phone: 435-419-9210
  • Fax: 435-216-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14247279-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: