Provider Demographics
NPI:1356480883
Name:WELBORN, REGINA K (CRNA)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:K
Last Name:WELBORN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:W
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 535575
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5595
Mailing Address - Country:US
Mailing Address - Phone:865-342-8900
Mailing Address - Fax:865-691-0843
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-495-7100
Practice Address - Fax:423-624-6355
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN80401367500000X
TNAPN12470367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3638644Medicaid
P00398193OtherRAILROAD MEDICARE
4146597OtherBCBS OF TN
TN3638644Medicare PIN