Active NPI
Carlos John Wells, LPN
- Licensed Practical Nurse
- Roosevelt, NY
National Provider Identifier
1912109356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 267953
- Practice address
- 9 Union Street
Roosevelt, NY 11575 - Phone
- (516) 379-2138
- NPI assigned
- Jun 5, 2007
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 267953 | NY | Primary |
Addresses
Primary practice location
9 Union Street
Roosevelt, NY 11575
Mailing address
167-19 142 Ave
Jamaica, NY 11434
Phone (718) 316-7945
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02415024 | Medicaid | NY |
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 |
|---|---|---|---|
| 267953 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912109356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "167-19 142 AVE",
"city": "JAMAICA",
"state": "NY",
"postal_code": "11434",
"telephone_number": "718-316-7945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 UNION STREET",
"city": "ROOSEVELT",
"state": "NY",
"postal_code": "11575",
"telephone_number": "516-379-2138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "CARLOS",
"middle_name": "JOHN",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "267953",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02415024",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roosevelt, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.