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Individual
KELLI TICE WELLS
Active
Individual
KELLI TICE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME82944
FL
208M00000X
Hospitalist Physician
ME82944
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009978895
—
AL
01
—
06241
BLUE CROSS BLUE SHIELD
FL
05
—
262522900
—
FL
01
—
59176263
BLUE CROSS BLUE SHIELD
AL
01
—
7804499
AETNA
—
01
—
P00195990
MEDICARE RAILROAD
—
Enumeration date
10/24/2005
Last updated
12/12/2012
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