Wellstar, Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

WELLSTAR, INC

Practice address

4217 Baymeadows Rd Ste 2
Jacksonville, FL 32217-4676

Phone

(904) 332-7431

Fax

(904) 332-7408

NPI assigned

Aug 28, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wendy C Lu

Title

Credentialing Manager

Phone

(904) 221-2535

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503878400000",
    "number": "1477070605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4217 BAYMEADOWS RD STE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4217 BAYMEADOWS RD STE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174676",
            "telephone_number": "904-332-7431",
            "fax_number": "904-332-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2017-08-28",
        "status": "A",
        "authorized_official_last_name": "LU",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "904-221-2535"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Wells
• Rudolph Lee Wells II, M.D.
• Savannah Wells, RBT
• Tiffany Wells, MD
• Tiffany Wells
• Wellsync Home Solutions LLC
• Ashley Elizabeth Welsh, APRN
• Erica L Welsh
• Kelli Marie Welsheimer, PT
• Alexa Beverly Welter, APRN

• Clinical Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.