Individual
MISS KATHRYN VAUGHN WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7945 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1762
(662) 983-9204
Mailing address
1993 MALLARD CV, SOUTHAVEN, MS 38672-9309
(662) 983-9204
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0000016824
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08938810
—
MS
05
—
Q007956
—
TN
Enumeration date
07/27/2012
Last updated
02/03/2017
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