MEDICARE: MR. RICHARD WALTER WELLENS MSN, APRN, AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	12117007	TX

General Provider Information

NPI Number	:	1386514297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD WALTER WELLENS MSN, APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	1619 BONNER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 FM 1464 RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-9542
Country	:	US
Telephone Number	:	832-626-3691
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	11/06/2025

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