Provider Demographics
NPI:1629244777
Name:WELCH, CRISSY DIANE (NP)
Entity Type:Individual
Prefix:
First Name:CRISSY
Middle Name:DIANE
Last Name:WELCH
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 1:12001 SOUTH FWY STE 302
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7215
Mailing Address - Country:US
Mailing Address - Phone:817-854-2210
Mailing Address - Fax:817-708-2150
Practice Address - Street 1:12001 SOUTH FWY STE 302
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7215
Practice Address - Country:US
Practice Address - Phone:817-854-2210
Practice Address - Fax:817-708-2150
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX686739OtherTEXAS LICENSE