Healthcare Provider Details

I. General information

NPI: 1730630849
Provider Name (Legal Business Name): KATELAN WELCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S SCHOOL ST
DERMOTT AR
71638-2127
US

IV. Provider business mailing address

PO BOX 509
DERMOTT AR
71638-0509
US

V. Phone/Fax

Practice location:
  • Phone: 870-538-3355
  • Fax:
Mailing address:
  • Phone: 870-538-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004935
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: