MEDICARE: DEVIN JAMES WELKER 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	363LF0000X	Family Nurse Practitioner	232489	AZ

General Provider Information

NPI Number	:	1255976858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN JAMES WELKER FNP-C

Provider Business Mailing Address
First Line	:	9225 N 3RD ST STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2455
Country	:	US
Telephone Number	:	602-362-2983
Fax Number	:	480-565-4552

Provider Business Practice Location Address
First Line	:	4135 S POWER RD STE 120
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-3626
Country	:	US
Telephone Number	:	480-892-7000
Fax Number	:	480-545-7001

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	08/12/2020

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