NPIMap

Individual provider Active NPI

Tiffany Eileen Wells, NP-C

  • Family Nurse Practitioner
  • Lewiston, ID
National Provider Identifier
1821509183
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
74327 Issued in ID
Practice address
415 6TH St
Lewiston, ID 83501-2434
Phone
(208) 750-7507
Fax
(208) 750-7384
NPI assigned
Oct 13, 2017
Last updated
Dec 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN198187 GA
Family Nurse Practitioner 363LF0000X 74327 ID Primary

Addresses

Primary practice location

415 6TH St
Lewiston, ID 83501-2434

Mailing address

415 6TH Street
Attn: Physician Services
Lewiston, ID 83501-2434
Phone (208) 750-7462

Other practice location 1

1762 Mars Hill Rd NW
Acworth, GA 30101-8091
Phone (678) 732-1506

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171220002412 GA Practitioner - Nurse Practitioner 4587922554 Reassigns benefits to 2 organizations
I20230316002817 ID Practitioner - Nurse Practitioner 4587922554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

415 6TH St
Lewiston, ID 83501-2431
Phone (208) 743-2511

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nissi Family Medicine LLC CurrentSince Aug 29, 2018 Accepting new patients
St Joseph Hospital LLC CurrentSince May 1, 2023 Accepting new patients
Harbin Clinic, LLC CurrentSince Nov 13, 2017 Accepting new patients
Harbin Clinic, LLC CurrentSince Nov 13, 2017 Accepting new patients
St. Joseph Hospital LLC Past Accepting new patients
Piedmont Medical Care Corporation Past Accepting new patients

Locations

1810 Mulkey Rd
Ste 105
Austell, GA 30106
Phone (678) 540-7597

150 Gentilly Blvd
Cartersville, GA 30120
Phone (678) 719-7000

1825 Martha Berry Blvd NW
Rome, GA 30165
Phone (706) 238-8073

221 Technology Pkwy NW
Rome, GA 30165
Phone (762) 235-1000

307 Saint Johns Way
Ste 11
Lewiston, ID 83501
Phone (208) 743-7612

341 Saint Johns Way
Lewiston, ID 83501
Phone (208) 750-7462

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

Interoperability endpoints

  • Direct secure messaging: tiffany.wells.1@16883.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1821509183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH STREET",
            "address_2": "ATTN: PHYSICIAN SERVICES",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012434",
            "telephone_number": "208-750-7462",
            "fax_number": "208-750-7467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012434",
            "telephone_number": "208-750-7507",
            "fax_number": "208-750-7384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1762 Mars Hill Rd NW",
            "address_purpose": "LOCATION",
            "city": "Acworth",
            "state": "GA",
            "postal_code": "301018091",
            "country_code": "US",
            "telephone_number": "678-732-1506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WELLS",
        "first_name": "TIFFANY",
        "middle_name": "EILEEN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-13",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN198187",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "74327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.