Provider Demographics
NPI:1518447648
Name:WELTER, CARRIE JENNIFER (NP-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JENNIFER
Last Name:WELTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3162 E SAGEBRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4318
Mailing Address - Country:US
Mailing Address - Phone:904-477-7579
Mailing Address - Fax:
Practice Address - Street 1:1784 UINTA WAY UNIT E2
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7685
Practice Address - Country:US
Practice Address - Phone:435-604-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5532535-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily