Provider Demographics
NPI:1457778839
Name:WELCH, LORETTA R (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:R
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:PO BOX 8749
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-8749
Mailing Address - Country:US
Mailing Address - Phone:432-522-1234
Mailing Address - Fax:432-522-2950
Practice Address - Street 1:3403 ANDREWS HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5132
Practice Address - Country:US
Practice Address - Phone:432-522-1234
Practice Address - Fax:432-522-2950
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily