Provider Demographics
NPI:1154434512
Name:WELCH, AMY SUE (CFNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:WELCH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44525 MARIETTA RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9209
Mailing Address - Country:US
Mailing Address - Phone:740-732-6851
Mailing Address - Fax:740-732-4029
Practice Address - Street 1:44525 MARIETTA RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9209
Practice Address - Country:US
Practice Address - Phone:740-732-6851
Practice Address - Fax:740-732-7425
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160856Medicaid
OHNP13811Medicare ID - Type Unspecified
OH0160856Medicaid