=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144341827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLOTTA MONIQUE WELLS DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1132 MALVERN AVE
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-762-8485
-----------------------------------------------------
Fax | 501-762-8085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1132 MALVERN AVE
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-762-8485
-----------------------------------------------------
Fax | 501-762-8085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 241
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------