Provider Demographics
NPI:1871950220
Name:WELLS, ALYSSA D (NP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:WELLS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:D
Other - Last Name:VANDERPLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2630 GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4053
Practice Address - Country:US
Practice Address - Phone:812-945-0145
Practice Address - Fax:812-949-5435
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006037A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily