Healthcare Provider Details

I. General information

NPI: 1295087104
Provider Name (Legal Business Name): ANDREA WELKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 2012 HIGHWAY 62/412
HARDY AR
72542
US

IV. Provider business mailing address

PO BOX 176
CHEROKEE VILLAGE AR
72525-0176
US

V. Phone/Fax

Practice location:
  • Phone: 870-257-3336
  • Fax:
Mailing address:
  • Phone: 870-856-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: