Provider Demographics
NPI:1740532993
Name:WELCH FORSBACH, KATHERINE (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WELCH FORSBACH
Suffix:
Gender:F
Credentials:FNP-C
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 1387
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-4387
Mailing Address - Country:US
Mailing Address - Phone:731-727-8366
Mailing Address - Fax:731-727-8367
Practice Address - Street 1:1565 WAYNE RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1581
Practice Address - Country:US
Practice Address - Phone:731-727-8366
Practice Address - Fax:731-727-8367
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007178Medicaid
TN103I503024Medicare PIN