Provider Demographics
NPI:1679579379
Name:WELCH, LORA (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-9567
Mailing Address - Country:US
Mailing Address - Phone:502-759-6532
Mailing Address - Fax:
Practice Address - Street 1:2120 PAYNE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2012
Practice Address - Country:US
Practice Address - Phone:502-895-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2708P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000000178845OtherANTHEM
KY78027083Medicaid
KYS78514Medicare UPIN
KY78027083Medicaid