Healthcare Provider Details

I. General information

NPI: 1689243420
Provider Name (Legal Business Name): NICOLE WELSH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 PYRAMID WAY
SPARKS NV
89431-5060
US

IV. Provider business mailing address

639 PYRAMID WAY
SPARKS NV
89431-5060
US

V. Phone/Fax

Practice location:
  • Phone: 775-245-2373
  • Fax: 775-245-2375
Mailing address:
  • Phone: 775-242-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WELSH
Title or Position: OWNER
Credential: MD
Phone: 775-245-2373