Provider Demographics
NPI:1255942348
Name:WELCH, CODY SCOTT
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:SCOTT
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8453 S FM 271
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-7352
Mailing Address - Country:US
Mailing Address - Phone:903-449-7574
Mailing Address - Fax:
Practice Address - Street 1:8453 S FM 271
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-7352
Practice Address - Country:US
Practice Address - Phone:903-449-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39171794374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide