MEDICARE: TRACI RENEE WELKER APRN

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	3007178	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497001408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI RENEE WELKER APRN

Provider Business Mailing Address
First Line	:	PO BOX 740017
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0017
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	1731 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-2313
Country	:	US
Telephone Number	:	502-444-6016
Fax Number	:

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

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	03/15/2023

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