MEDICARE: HEATHER ELAINE WELLS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS14757	FL
2	207Q00000X	Family Medicine Physician	DOS-2231	HI

General Provider Information

NPI Number	:	1326458159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ELAINE WELLS D.O.

Provider Business Mailing Address
First Line	:	849 W GULF BEACH DR
Second Line	:
City	:	SAINT GEORGE ISLAND
State	:	FL
Zip	:	32328-2512
Country	:	US
Telephone Number	:	850-419-7319
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 HIGHWAY 22
Second Line	:
City	:	WEWAHITCHKA
State	:	FL
Zip	:	32465-3237
Country	:	US
Telephone Number	:	850-568-1053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2025

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