Individual
CATHERINE C. WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF NEPHROLOGY, JACKSON, MS 39216-4500
(601) 984-5687
Mailing address
2500 NORTH STATE STREET, DEPT OF MEDICINE, JACKSON, MS 39216-4500
(601) 984-5687
(601) 984-5765
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
R857433
MS
363L00000X
Nurse Practitioner
Primary
R857433
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01057053
—
MS
01
—
P01648524
RAILROAD MEDICARE PTAN
MS
Enumeration date
11/21/2006
Last updated
06/29/2016
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