Provider Demographics
NPI:1205000304
Name:THE CLINIC OF WELSH
Entity Type:Organization
Organization Name:THE CLINIC OF WELSH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:HEBERT
Authorized Official - Last Name:KRIELOW
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:337-734-4500
Mailing Address - Street 1:7533 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:LA
Mailing Address - Zip Code:70581-3505
Mailing Address - Country:US
Mailing Address - Phone:337-734-4500
Mailing Address - Fax:337-734-4400
Practice Address - Street 1:7533 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:LA
Practice Address - Zip Code:70581-3505
Practice Address - Country:US
Practice Address - Phone:337-753-2579
Practice Address - Fax:337-753-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN066886261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141046Medicaid
LA4C410Medicare PIN