Provider Demographics
NPI:1235305962
Name:THE CLINIC OF WELSH
Entity Type:Organization
Organization Name:THE CLINIC OF WELSH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIELOW
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,FNP-BC
Authorized Official - Phone:337-734-4500
Mailing Address - Street 1:708 E RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:WELSH
Mailing Address - State:LA
Mailing Address - Zip Code:70591-4844
Mailing Address - Country:US
Mailing Address - Phone:337-734-4500
Mailing Address - Fax:337-734-4400
Practice Address - Street 1:708 E RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:WELSH
Practice Address - State:LA
Practice Address - Zip Code:70591-4844
Practice Address - Country:US
Practice Address - Phone:337-734-4500
Practice Address - Fax:337-734-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN066886AP0397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141046Medicaid
LA1141046Medicaid