MEDICARE: PETRA WELCH FNP

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	613437	TX
2	363LF0000X	Family Nurse Practitioner	AP116020	TX

General Provider Information

NPI Number	:	1851590087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETRA WELCH FNP

Provider Business Mailing Address
First Line	:	PO BOX 938
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76540-0938
Country	:	US
Telephone Number	:	254-634-6999
Fax Number	:	254-200-4099

Provider Business Practice Location Address
First Line	:	36029 58TH STREET
Second Line	:
City	:	FT. CAVAZOS
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:	254-287-7169
Fax Number	:

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	02/12/2025

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