Healthcare Provider Details

I. General information

NPI: 1356480883
Provider Name (Legal Business Name): REGINA K WELBORN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REGINA W HALL CRNA

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 HAMILL RD
HIXSON TN
37343
US

IV. Provider business mailing address

PO BOX 535575
ATLANTA GA
30353-5595
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7100
  • Fax: 423-624-6355
Mailing address:
  • Phone: 865-342-8900
  • Fax: 865-691-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN80401
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN12470
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: