Provider Demographics
NPI:1881929818
Name:WELSH, TRACY (CRNA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WELSH
Suffix:
Gender:F
Credentials:CRNA
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 7
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37621-0007
Mailing Address - Country:US
Mailing Address - Phone:423-968-4540
Mailing Address - Fax:423-968-5697
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-968-4540
Practice Address - Fax:423-968-5697
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6214A367500000X
TN14944367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10I3436543Medicare PIN