Provider Demographics
NPI:1760941348
Name:WELCH, MEGHAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUNSET DR STE Z
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4082
Mailing Address - Country:US
Mailing Address - Phone:662-307-9027
Mailing Address - Fax:
Practice Address - Street 1:1300 SUNSET DR STE Z
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4082
Practice Address - Country:US
Practice Address - Phone:662-307-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health