Active NPI
Kevin Dale Wells, PA
- Emergency Medicine Physician
- Dallas, TX
National Provider Identifier
1154447977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 1495
- Practice address
- 17304 Preston Rd
Suite 555
Dallas, TX 75252-5618 - Phone
- (866) 931-8882
- Fax
- (972) 934-3174
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 1495 | OK | Primary |
Addresses
Primary practice location
17304 Preston Rd
Suite 555
Dallas, TX 75252-5618
Mailing address
4409 Blue Sage CT
Norman, OK 73072-3953
Phone (405) 701-3608
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1435 | OK | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dickinson & Wells PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Medical Physician Assistant
- Daingerfield, TX
- NPI 1710176805
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154447977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4409 BLUE SAGE CT",
"city": "NORMAN",
"state": "OK",
"postal_code": "730723953",
"telephone_number": "405-701-3608",
"fax_number": "405-310-5092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17304 PRESTON RD",
"address_2": "SUITE 555",
"city": "DALLAS",
"state": "TX",
"postal_code": "752525618",
"telephone_number": "866-931-8882",
"fax_number": "972-934-3174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "KEVIN",
"middle_name": "DALE",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OK",
"license": "1495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.