Provider Demographics
NPI:1730116484
Name:WELCH, KAREN MISHRELL (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MISHRELL
Last Name:WELCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865-9648
Mailing Address - Country:US
Mailing Address - Phone:607-535-8639
Mailing Address - Fax:607-535-7157
Practice Address - Street 1:230 STEUBEN ST
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865-9648
Practice Address - Country:US
Practice Address - Phone:607-535-8639
Practice Address - Fax:607-535-7157
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMW0060878OtherDEA
NYP00608Medicare UPIN