Provider Demographics
NPI:1184924698
Name:WELBORN, ALICIA G (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:G
Last Name:WELBORN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:B
Other - Last Name:GAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-C
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-4100
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-31
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004953363LA2200X
NC214234363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1204AMedicaid
NC7004665Medicare PIN