MEDICARE: JODI L. WELLS PA-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	363A00000X	Physician Assistant	2457	NV

General Provider Information

NPI Number	:	1457411712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI L. WELLS PA-C

Provider Business Mailing Address
First Line	:	7140 SMOKE RANCH RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3157
Country	:	US
Telephone Number	:	702-320-8111
Fax Number	:	702-320-8112

Provider Business Practice Location Address
First Line	:	7140 SMOKE RANCH RD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3157
Country	:	US
Telephone Number	:	702-320-8111
Fax Number	:	702-320-8112

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

Provider Enumeration Date	:	12/09/2006
Last Update Date	:	03/09/2026

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