Provider Demographics
NPI:1265403661
Name:WELBORN, LAURA L (ARNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:WELBORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW 6TH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:2200 SW 6TH AVE
Practice Address - Street 2:STE 104
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1707
Practice Address - Country:US
Practice Address - Phone:785-354-8518
Practice Address - Fax:785-354-1255
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
500024979OtherRR MEDICARE
KS100375530BMedicaid
500024979OtherRR MEDICARE
KSP30282Medicare UPIN