Healthcare Provider Details

I. General information

NPI: 1649010851
Provider Name (Legal Business Name): ELISE WELSH DNP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BINGHAM RD
BOONVILLE MO
65233-2229
US

IV. Provider business mailing address

1742 W WOODIE PROCTOR RD
COLUMBIA MO
65203-8886
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-8018
  • Fax:
Mailing address:
  • Phone: 573-424-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELISE PILGER
Title or Position: NURSE PRACTITIONER
Credential: DNP, AGNP-C
Phone: 573-424-2421