Merry Wells, CNP
Individual provider Active NPI Nurse Practitioner · Columbus, MS
NPI 1497112403 · NPPES record last updated Jan 4, 2019
Key facts
- NPI
- 1497112403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 901416 (MS)
- Practice address
- 2475 5TH St N
Columbus, MS 39705-2005 - Phone
- (662) 328-1254
- NPI assigned
- Jan 21, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160217000862 | MS | Practitioner - Nurse Practitioner | 5991000770 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 901416 | MS | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caledonia Community Clinic, LLC | Current |
Accepting new patients | |
| Fig Leaf, LLC | Nurse Practitioner | Current | Accepting new patients |
Interoperability endpoints
- merry.wells.1@23614.direct.athenahealth.com
- https://api.platform.athenahealth.com/23614/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 901416 | MS | Yes |
Addresses
Primary practice location
2475 5TH St N
Columbus, MS 39705-2005
Mailing address
2475 5TH St N
Columbus, MS 39705-2005
Phone (662) 328-1254
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08156515 | Medicaid | MS |
Other providers in Columbus, MS
- Clare Weitz
- Errole Hope Glidewell Welch
- Ron Welch
- Wells Counseling Associates, Inc
- Debbie K Wells
- Ryan Wendt
- Jeremy Westbrook
- Westmoreland Dermatology & Surgery Center, PA
- Westmoreland Dermatology and Surgery Center
- Terry Westmoreland
All providers in Columbus, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.