Provider Demographics
NPI:1831704105
Name:WELCH, TANYA (MSN, APRN, AGNP-BC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:TX
Mailing Address - Zip Code:75966-3009
Mailing Address - Country:US
Mailing Address - Phone:409-379-2188
Mailing Address - Fax:409-379-2188
Practice Address - Street 1:1304 W COURT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:TX
Practice Address - Zip Code:75966-3009
Practice Address - Country:US
Practice Address - Phone:409-379-2177
Practice Address - Fax:409-379-2188
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716826163WG0600X
TX1022925363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology