Healthcare Provider Details

I. General information

NPI: 1952723637
Provider Name (Legal Business Name): ELIZABETH WELCH RN, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH LIEUDELL SMITH RN, ACNS-BC

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

PO BOX 732973
DALLAS TX
75373-2973
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3431
  • Fax: 827-927-3603
Mailing address:
  • Phone: 817-702-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAP124190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: