MEDICARE: HEIDI LEE WELCH FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	12379690-4405	UT
2	163W00000X	Registered Nurse	12379690-3102	UT

General Provider Information

NPI Number	:	1073493425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI LEE WELCH FNP-C

Provider Business Mailing Address
First Line	:	2015 E ASHLEY RIDGE RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-7260
Country	:	US
Telephone Number	:	801-824-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 E COTTONWOOD PKWY STE 540
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-7298
Country	:	US
Telephone Number	:	801-278-9062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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