Provider Demographics
NPI:1447936125
Name:WELCH, JAMIE LEA (CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEA
Last Name:WELCH
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CENTENNIAL ST STE B
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5985
Mailing Address - Country:US
Mailing Address - Phone:301-200-3032
Mailing Address - Fax:
Practice Address - Street 1:103 CENTENNIAL ST STE C
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5985
Practice Address - Country:US
Practice Address - Phone:301-934-9111
Practice Address - Fax:301-934-9333
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily