Provider Demographics
NPI:1679637185
Name:WELDEN, BRETT L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:L
Last Name:WELDEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:BRETT
Other - Middle Name:L
Other - Last Name:WELDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1333 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2046
Mailing Address - Country:US
Mailing Address - Phone:417-967-1265
Mailing Address - Fax:417-967-1234
Practice Address - Street 1:1333 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-3311
Practice Address - Fax:417-967-1234
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671959363LF0000X, 367500000X
MO2015014592363LF0000X
MO2015014593367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO910026517Medicaid
MO26D0446923OtherCLIA
MO2015014592OtherFNP