Provider Demographics
NPI:1972587780
Name:WALSH, KATHLEEN J (APN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:WALSH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 THE VILLAGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2742
Mailing Address - Country:US
Mailing Address - Phone:828-631-1960
Mailing Address - Fax:828-586-3489
Practice Address - Street 1:70 THE VILLAGE OVERLOOK
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2742
Practice Address - Country:US
Practice Address - Phone:828-631-1960
Practice Address - Fax:828-586-3489
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007359363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209002272OtherLICENSE
NC273514OtherRN LICENSE
NC5007359OtherNP LICENSE