Active NPI
David Matthew Wells
- Psychologist
- Plymouth, MN
National Provider Identifier
1548696602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP5931
- Practice address
- 11505 36TH Ave N
Plymouth, MN 55441-2304 - Phone
- (763) 509-3800
- NPI assigned
- Sep 20, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychologist | 103T00000X | LP5931 | MN | Primary |
Addresses
Primary practice location
11505 36TH Ave N
Plymouth, MN 55441-2304
Mailing address
11505 36TH Ave N
Plymouth, MN 55441-2304
Phone (763) 509-3800
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP5931 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561593600000",
"number": "1548696602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11505 36TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412304",
"telephone_number": "763-509-3800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11505 36TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412304",
"telephone_number": "763-509-3800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "DAVID",
"middle_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-20",
"last_updated": "2019-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP5931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.