Healthcare Provider Details

I. General information

NPI: 1396556502
Provider Name (Legal Business Name): KATHERINE M WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 RAILROAD FLAT RD 6
MOKELUMNE HILL CA
95245
US

IV. Provider business mailing address

PO BOX 844
MOUNTAIN RANCH CA
95246-0844
US

V. Phone/Fax

Practice location:
  • Phone: 209-897-0603
  • Fax:
Mailing address:
  • Phone: 669-639-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberC5776766
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: