Healthcare Provider Details

I. General information

NPI: 1093444309
Provider Name (Legal Business Name): AMANDA L. WELCH APRN-CNP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 N HARRISON ST
SHAWNEE OK
74804-3131
US

IV. Provider business mailing address

36264 EW 1190
SEMINOLE OK
74868-6622
US

V. Phone/Fax

Practice location:
  • Phone: 405-585-2030
  • Fax: 405-857-3122
Mailing address:
  • Phone: 405-905-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number208180
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: