Provider Demographics
NPI:1861649477
Name:WELDEN, CAROL L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:WELDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-8510
Mailing Address - Country:US
Mailing Address - Phone:970-625-6496
Mailing Address - Fax:719-589-5722
Practice Address - Street 1:128 MARKET ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2290
Practice Address - Country:US
Practice Address - Phone:719-589-5161
Practice Address - Fax:719-589-5722
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO189325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62570790Medicaid
CO62570790Medicaid