MEDICARE: JENNIFER STACY WELLS RD

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	133V00000X	Registered Dietitian	294932	KY

General Provider Information

NPI Number	:	1851228043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER STACY WELLS RD

Provider Business Mailing Address
First Line	:	740 S LIMESTONE
Second Line	:	SECOND FLOOR WING D
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE
Second Line	:	SECOND FLOOR WING D
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-218-1676
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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