Provider Demographics
NPI:1932447760
Name:WELDY, KRISTINE MICHELLE (APN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MICHELLE
Last Name:WELDY
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:2102 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-9310
Practice Address - Country:US
Practice Address - Phone:574-862-2165
Practice Address - Fax:574-862-4112
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004302A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300010001Medicaid
IL236040286OtherMEDICARE PTAN