Provider Demographics
NPI:1396385829
Name:WELCH, DEANNA CAROL (APRN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:CAROL
Last Name:WELCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:DEANNA
Other - Middle Name:C
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1806 CLEAR SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5368
Mailing Address - Country:US
Mailing Address - Phone:817-992-3201
Mailing Address - Fax:
Practice Address - Street 1:1806 CLEAR SUMMIT LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5368
Practice Address - Country:US
Practice Address - Phone:817-992-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner