# WELLLIFE PRIMARY CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336401058
- **Authorized official:** DWAN KELSEY NP (OWNER)
- **Authorized official phone:** (919) 829-1315

## Contact information

- **Practice address:** 211 E SIX FORKS RD, SUITE 122, RALEIGH, NC 27609-7745
- **Practice address phone:** (919) 829-1315
- **Mailing address:** 211 E SIX FORKS RD, SUITE 122, RALEIGH, NC 27609-7745
- **Mailing address phone:** (919) 829-1315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 136549 | NC | Yes |

## Other

- **Enumeration date:** 06/08/2012
- **Last updated:** 06/08/2012