Provider Demographics
NPI:1659763134
Name:WELSH, TYRA (NP-C)
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:
Last Name:WELSH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TYRA
Other - Middle Name:JOHNSON
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:20366 CHAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7493
Mailing Address - Country:US
Mailing Address - Phone:225-413-5995
Mailing Address - Fax:
Practice Address - Street 1:200 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3870
Practice Address - Country:US
Practice Address - Phone:800-893-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08242363L00000X
LARN117922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse