Provider Demographics
NPI:1851590087
Name:WELCH, PETRA (FNP)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2300 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4984
Practice Address - Country:US
Practice Address - Phone:254-519-1900
Practice Address - Fax:254-519-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8451Medicare PIN