Provider Demographics
NPI:1184957060
Name:WELLS, KIMBERLY ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:WELLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:BURROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2000 N ELM ST
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2385
Mailing Address - Country:US
Mailing Address - Phone:270-844-8144
Mailing Address - Fax:270-844-8145
Practice Address - Street 1:1300 MERRITT DR STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2788
Practice Address - Country:US
Practice Address - Phone:270-827-0064
Practice Address - Fax:270-826-3338
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006176363LA2200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100088520Medicaid