Healthcare Provider Details

I. General information

NPI: 1588119176
Provider Name (Legal Business Name): ELIZABETH DANIELLE WELCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE WELCH NP

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 JEFFERSON ST
LAUREL MS
39440-4354
US

IV. Provider business mailing address

1203 JEFFERSON ST
LAUREL MS
39440-4354
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-2863
  • Fax: 601-649-9479
Mailing address:
  • Phone: 601-649-2863
  • Fax: 601-649-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901533
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: