Provider Demographics
NPI:1871294876
Name:WELLS, SAMANTHA HENDERSON (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:HENDERSON
Last Name:WELLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3022
Mailing Address - Country:US
Mailing Address - Phone:804-363-3050
Mailing Address - Fax:
Practice Address - Street 1:14051 ST FRANCIS BLVD STE 2210
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3203
Practice Address - Country:US
Practice Address - Phone:804-363-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily