# THE WELL WAGON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Well of KY, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598363509
- **Authorized official:** MS. KIMBERLY M SPAHN FNP-BC (CEO, OWNER)
- **Authorized official phone:** (812) 430-2633

## Contact information

- **Practice address:** 2124 DOGOON DR, LOUISVILLE, KY 40223-1147
- **Practice address phone:** (812) 430-2633
- **Mailing address:** 2124 DOGOON DR, LOUISVILLE, KY 40223-1147

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2020
- **Last updated:** 10/12/2020