Healthcare Provider Details

I. General information

NPI: 1104337146
Provider Name (Legal Business Name): SHERYL LYNN WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14312 HIGHWAY 9
MALVERN AR
72104-5880
US

IV. Provider business mailing address

14312 HIGHWAY 9
MALVERN AR
72104-5880
US

V. Phone/Fax

Practice location:
  • Phone: 501-467-5090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberNURP6588
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: