Provider Demographics
NPI:1174921258
Name:WELKER, PENNY L
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:WELKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N HIGHWAY 92 STE B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-3687
Mailing Address - Country:US
Mailing Address - Phone:865-647-3400
Mailing Address - Fax:865-647-3401
Practice Address - Street 1:1004 N HIGHWAY 92 STE B
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-3687
Practice Address - Country:US
Practice Address - Phone:865-647-3400
Practice Address - Fax:865-647-3401
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014367Medicaid