Provider Demographics
NPI:1386033645
Name:WELLS, DAVENE (PA-C)
Entity type:Individual
Prefix:
First Name:DAVENE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAVENE
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8331 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6589
Mailing Address - Country:US
Mailing Address - Phone:901-230-5581
Mailing Address - Fax:
Practice Address - Street 1:146 TIMBER CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4474
Practice Address - Country:US
Practice Address - Phone:901-751-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2684363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical