Healthcare Provider Details

I. General information

NPI: 1578605101
Provider Name (Legal Business Name): KRESSA DAWN WELCH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 TOWNSGATE PLZ
CLOVIS NM
88101-3714
US

IV. Provider business mailing address

121 TOWNSGATE PLZ
CLOVIS NM
88101-3714
US

V. Phone/Fax

Practice location:
  • Phone: 575-742-2620
  • Fax:
Mailing address:
  • Phone: 575-742-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: