MEDICARE: DANIEL PATRICK WELCH AGNP-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	363LG0600X	Gerontology Nurse Practitioner	903574	MS

General Provider Information

NPI Number	:	1497396394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PATRICK WELCH AGNP-C

Provider Business Mailing Address
First Line	:	144 BURNHAM RD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39042-2534
Country	:	US
Telephone Number	:	769-798-0919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 THOMPSON RD
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2125
Country	:	US
Telephone Number	:	541-269-8111
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	03/09/2026

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