Provider Demographics
NPI:1861381865
Name:WELCH, GARRETT BRADLEY
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:BRADLEY
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5294 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8873
Mailing Address - Country:US
Mailing Address - Phone:580-224-1150
Mailing Address - Fax:
Practice Address - Street 1:5294 KINGS RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-8873
Practice Address - Country:US
Practice Address - Phone:580-224-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKA20518183390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program