Provider Demographics
NPI:1174519003
Name:WELCH, AMY D (PA-C,)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:D
Last Name:WELCH
Suffix:
Gender:F
Credentials:PA-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2343
Mailing Address - Country:US
Mailing Address - Phone:515-248-1500
Mailing Address - Fax:
Practice Address - Street 1:1200 UNIVERSITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2343
Practice Address - Country:US
Practice Address - Phone:515-248-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001913363AM0700X
IA0020501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical