Provider Demographics
NPI:1518060508
Name:WELCOME, STACY CATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:CATHERINE
Last Name:WELCOME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 LENNON LN STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5912
Mailing Address - Country:US
Mailing Address - Phone:925-947-2334
Mailing Address - Fax:925-947-5889
Practice Address - Street 1:365 LENNON LN STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5912
Practice Address - Country:US
Practice Address - Phone:925-947-2334
Practice Address - Fax:925-947-5889
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16241OtherMEDICAL LICENSE