Provider Demographics
NPI:1235990904
Name:WELTSCH, JENNIFER KELLY (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLY
Last Name:WELTSCH
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KELLY
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6242 E ARBOR AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1309
Mailing Address - Country:US
Mailing Address - Phone:602-805-4914
Mailing Address - Fax:602-805-4917
Practice Address - Street 1:6242 E ARBOR AVE STE 118
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1309
Practice Address - Country:US
Practice Address - Phone:602-805-4914
Practice Address - Fax:602-805-4917
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ306679363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ306679OtherRN
AZ186528Medicaid