Provider Demographics
NPI:1861774713
Name:WELSH, TAWNY NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:NICOLE
Last Name:WELSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAWNY
Other - Middle Name:NICOLE
Other - Last Name:SCHMEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 440
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-3766
Practice Address - Fax:503-297-8148
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA156597363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500641513Medicaid
WA1861774713Medicaid
OR500641513Medicaid
ORP01321378Medicare PIN