Provider Demographics
NPI:1396556502
Name:WELCH, KATHERINE M
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95246-0844
Mailing Address - Country:US
Mailing Address - Phone:669-639-0704
Mailing Address - Fax:
Practice Address - Street 1:1475 RAILROAD FLAT RD
Practice Address - Street 2:6
Practice Address - City:MOKELUMNE HILL
Practice Address - State:CA
Practice Address - Zip Code:95245
Practice Address - Country:US
Practice Address - Phone:209-897-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC5776766172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver