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NPI Code Detail

MEDICARE: MR. DARREL L. WELBURN FNP-C

MEDICARE: MR. DARREL L. WELBURN 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
1363LF0000XFamily Nurse Practitioner1168479TX
2163WM0705XMedical-Surgical Registered NurseR39751NM

General Provider Information

NPI Number : 1174602569
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DARREL L. WELBURN FNP-C
Provider Business Mailing Address
First Line : PO BOX 25
Second Line :
City : CLIFF
State : NM
Zip : 88028-0025
Country : US
Telephone Number : 915-503-3085
Fax Number :
Provider Business Practice Location Address
First Line : 12350 PASEO NUEVO DR
Second Line :
City : EL PASO
State : TX
Zip : 79928-5668
Country : US
Telephone Number : 915-225-4470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2006
Last Update Date : 09/27/2024

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