Healthcare Provider Details

I. General information

NPI: 1780986372
Provider Name (Legal Business Name): CHERYL L WALSH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR STE 550
SPRINGDALE AR
72762-6362
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 479-903-4764
  • Fax: 479-346-1851
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR71389
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberATP-000343
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA03519 ANP
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA003519
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: