Provider Demographics
NPI:1669234589
Name:WELCH, KARIESSA TAYLOR (FNP-C)
Entity type:Individual
Prefix:
First Name:KARIESSA
Middle Name:TAYLOR
Last Name:WELCH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KARIESSA
Other - Middle Name:TAYLOR
Other - Last Name:ROSENLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:20734 E MAYA RD STE 101
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-2651
Practice Address - Country:US
Practice Address - Phone:888-663-6631
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ236624363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily