Provider Demographics
NPI:1255880134
Name:WELCH, JENNY ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ELIZABETH
Last Name:WELCH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2132
Mailing Address - Country:US
Mailing Address - Phone:423-784-3600
Mailing Address - Fax:
Practice Address - Street 1:292 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2132
Practice Address - Country:US
Practice Address - Phone:423-784-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000021842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily