Active NPI
Eric N Wells, PA
- Physician Assistant
- Nampa, ID
National Provider Identifier
1609943935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-642
- Practice address
- 215 E Hawaii Avenue
Nampa, ID 83686 - Phone
- (208) 463-3234
- Fax
- (208) 463-3044
- NPI assigned
- Nov 30, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-642 | ID | Primary |
Addresses
Primary practice location
215 E Hawaii Avenue
Nampa, ID 83686
Mailing address
217 W Georgia Ave
Suite 115
Nampa, ID 83686-6811
Phone (208) 463-3234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807594700 | Medicaid | ID |
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 |
|---|---|---|---|
| PA-642 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260748800000",
"number": "1609943935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 W GEORGIA AVE",
"address_2": "SUITE 115",
"city": "NAMPA",
"state": "ID",
"postal_code": "836866811",
"telephone_number": "208-463-3234",
"fax_number": "208-463-3044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 E HAWAII AVENUE",
"city": "NAMPA",
"state": "ID",
"postal_code": "83686",
"telephone_number": "208-463-3234",
"fax_number": "208-463-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "ERIC",
"middle_name": "N",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2009-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-642",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807594700",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.