Provider Demographics
NPI:1215653639
Name:WELCH, TRISTA LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:LYNN
Last Name:WELCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BALLARD RD TRLR 19
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-2232
Mailing Address - Country:US
Mailing Address - Phone:518-334-5205
Mailing Address - Fax:
Practice Address - Street 1:120 BALLARD RD TRLR 19
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-2232
Practice Address - Country:US
Practice Address - Phone:518-334-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279663-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse