Individual
CATHY LOUISE WELCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
Mailing address
14449 N 525 RD, TAHLEQUAH, OK 74464-0443
(918) 431-1599
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA769
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100313470B
—
OK
05
—
200000030A
—
OK
01
—
400522239
MEDICARE GROUP PTAN
OK
Enumeration date
11/02/2005
Last updated
05/14/2008
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