Provider Demographics
NPI:1255805768
Name:WELCH, KRISTIN CAROL (MSN, APNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CAROL
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSN, APNP, FNP-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:CAROL
Other - Last Name:FULTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2216 WOODHILL WAY
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7722
Mailing Address - Country:US
Mailing Address - Phone:262-352-6461
Mailing Address - Fax:
Practice Address - Street 1:240 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8475
Practice Address - Country:US
Practice Address - Phone:262-928-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8716-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily