Provider Demographics
NPI:1235455064
Name:WELTY, BARBARA SHEHAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SHEHAN
Last Name:WELTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:JOAN
Other - Last Name:SHEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42335 WASHINGTON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8031
Mailing Address - Country:US
Mailing Address - Phone:760-345-5390
Mailing Address - Fax:
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 212
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:760-327-7905
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500829163W00000X
CA19698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101240Medicaid
CAZZZ27958ZOtherMEDICARE GROU PTAN
CAGR0101241Medicaid
CAGR0101242Medicaid