Provider Demographics
NPI:1386932150
Name:WELCH, WHITNEY RAE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:RAE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BROMLEY PL APT A304
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-1614
Mailing Address - Country:US
Mailing Address - Phone:870-917-7104
Mailing Address - Fax:
Practice Address - Street 1:3200 BROMLEY PL APT A304
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-1614
Practice Address - Country:US
Practice Address - Phone:870-917-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered