Provider Demographics
NPI:1275004335
Name:WELSH, KIMBERLY MARIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIA
Last Name:WELSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:MARIA
Other - Last Name:LONGMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4901 E FOREST SERVICE 3040 RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-9478
Mailing Address - Country:US
Mailing Address - Phone:520-954-2751
Mailing Address - Fax:
Practice Address - Street 1:3285 E SPARROW AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7794
Practice Address - Country:US
Practice Address - Phone:928-527-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN130984163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool