Provider Demographics
NPI:1043267586
Name:WELCH, JEWEL B (CRNAP)
Entity Type:Individual
Prefix:MRS
First Name:JEWEL
Middle Name:B
Last Name:WELCH
Suffix:
Gender:F
Credentials:CRNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NOVUS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8236
Mailing Address - Country:US
Mailing Address - Phone:423-283-0776
Mailing Address - Fax:
Practice Address - Street 1:1009 NOVUS DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8236
Practice Address - Country:US
Practice Address - Phone:423-283-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024065100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100034030Medicaid
VA010087708Medicaid
KY7100034030Medicaid
VAQ38932AMedicare PIN
VA00V978M05Medicare PIN
VA010087708Medicaid