Provider Demographics
NPI:1144341827
Name:WELLS, CARLOTTA MONIQUE (DPM)
Entity type:Individual
Prefix:DR
First Name:CARLOTTA
Middle Name:MONIQUE
Last Name:WELLS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-762-8485
Mailing Address - Fax:501-762-8085
Practice Address - Street 1:1132 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6347
Practice Address - Country:US
Practice Address - Phone:501-762-8485
Practice Address - Fax:501-762-8085
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR241213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR241OtherLICENSE
AR165479717Medicaid