Provider Demographics
NPI:1750128138
Name:WELBORN, SAMMY (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:WELBORN
Suffix:
Gender:M
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 1:28819 PFEIFFERS GATE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4784
Mailing Address - Country:US
Mailing Address - Phone:936-662-7594
Mailing Address - Fax:
Practice Address - Street 1:12840 W INTERSTATE 10 STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2361
Practice Address - Country:US
Practice Address - Phone:210-817-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily