Provider Demographics
NPI:1952723637
Name:WELCH, ELIZABETH (RN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:RN, ACNS-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LIEUDELL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ACNS-BC
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-702-3431
Practice Address - Fax:827-927-3603
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124190364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health