Healthcare Provider Details

I. General information

NPI: 1679637185
Provider Name (Legal Business Name): BRETT L WELDEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRETT L WELDEN FNP-BC

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

IV. Provider business mailing address

1333 S SAM HOUSTON BLVD
HOUSTON MO
65483-2046
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-3311
  • Fax: 417-967-1234
Mailing address:
  • Phone: 417-967-1265
  • Fax: 417-967-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number671959
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015014592
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number671959
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2015014593
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: