Provider Demographics
NPI:1518582550
Name:WELSH, MARYKATE (NP)
Entity Type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:WELSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2601
Mailing Address - Country:US
Mailing Address - Phone:717-859-8000
Mailing Address - Fax:
Practice Address - Street 1:1170 S STATE ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2601
Practice Address - Country:US
Practice Address - Phone:717-859-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN627315163W00000X
PASP024376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN627315OtherRN LICENSE
PASP024376OtherNURSE PRACTITIONER LICENSE