Provider Demographics
NPI:1740964030
Name:WELCH, KIMBERLY (RN, AGPCNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:RN, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WINDING HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2241
Mailing Address - Country:US
Mailing Address - Phone:214-499-5777
Mailing Address - Fax:
Practice Address - Street 1:225 E STATE HIGHWAY 121 STE 110
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2180
Practice Address - Country:US
Practice Address - Phone:214-499-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2023036351363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology