| Doctor Name: | KIMBERLY WELLS |
| NPI Number: | 1699123471 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 4704210008 |
| Business Practice Address: | 519 E Brook Dr Newaygo, MI - 493378573 |
| Business Phone Number: | 2312504073 |
| Business Fax Number: | |
| Mailing Address: | 519 E Brook Dr, NEWAYGO |
| State: | MI |
| Postal Code: | 493378573 |
| Phone Number: | 2312504073 |
| Fax Number: | |
| NPI Enumeration Date: | 06/02/2016 |
| NPI Last Update Date: | 06/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA0400X |
| License Number: | 4704210008 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |