MEDICARE: MS. GAIL T WELLS RN,MS,FNP-C

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	163W00000X	Registered Nurse	504124	TX
2	363LF0000X	Family Nurse Practitioner	AP104815	TX

General Provider Information

NPI Number	:	1417938879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL T WELLS RN,MS,FNP-C

Provider Business Mailing Address
First Line	:	12714 AZALEA CREEK TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3207
Country	:	US
Telephone Number	:	281-894-7098
Fax Number	:	281-890-3844

Provider Business Practice Location Address
First Line	:	10311 N ELDRIDGE PKWY
Second Line	:	STE. B5
City	:	HOUSTON
State	:	TX
Zip	:	77065-5368
Country	:	US
Telephone Number	:	281-890-3822
Fax Number	:	281-890-3844

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2020

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