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1972593820

NPI Code Detail

MEDICARE: KELLI TICE WELLS MD

MEDICARE: KELLI TICE WELLS MD

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	208M00000X	Hospitalist Physician	ME82944	FL
2	207Q00000X	Family Medicine Physician	ME82944	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00195990	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	59176263	OTHER	AL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	06241	OTHER	FL	BLUE CROSS BLUE SHIELD
6	7804499	OTHER		AETNA

General Provider Information

NPI Number	:	1972593820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI TICE WELLS MD

Provider Business Mailing Address
First Line	:	1295 W FAIRFIELD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-1107
Country	:	US
Telephone Number	:	850-595-6501
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 W FAIRFIELD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-1107
Country	:	US
Telephone Number	:	850-595-6500
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	12/12/2012

Similar Medicare Providers

1295763712 — FLORIDA DEPARTMENT OF HEALTH
Practice Location Address:

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1629033204 — DR. WILLIAM WALLACE ROGERS III DDS
Practice Location Address:

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Practice Location Address:

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1366409807 — DR. LAWRENCE LUTHER COPENHAVER III DMD
Practice Location Address:

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Practice Phone: 850-912-8880
Practice Fax: 850-912-8779

1144287673 — MS. ARIANNA ROBINS HAHN ARNP
Practice Location Address:

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PENSACOLA, FL
32501-1107

Practice Phone: 850-595-6679
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1386601755 — MS. KATHRYN JOAN ONEAL ARNP
Practice Location Address:

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Directions to “ KELLI TICE WELLS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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