Provider Demographics
NPI:1336797380
Name:WELDON, ANNIE ELISE
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:ELISE
Last Name:WELDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 JUDGE CARR RD
Mailing Address - Street 2:
Mailing Address - City:WHITEWRIGHT
Mailing Address - State:TX
Mailing Address - Zip Code:75491-3934
Mailing Address - Country:US
Mailing Address - Phone:903-818-3631
Mailing Address - Fax:
Practice Address - Street 1:930 JUDGE CARR RD
Practice Address - Street 2:
Practice Address - City:WHITEWRIGHT
Practice Address - State:TX
Practice Address - Zip Code:75491-3934
Practice Address - Country:US
Practice Address - Phone:903-818-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant