Provider Demographics
NPI:1194402966
Name:WALSH, KATIE HELMS (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:HELMS
Last Name:WALSH
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 1:2524 SHUFORD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7459
Mailing Address - Country:US
Mailing Address - Phone:704-591-1583
Mailing Address - Fax:
Practice Address - Street 1:315 1ST AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6169
Practice Address - Country:US
Practice Address - Phone:828-838-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13332363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant