Healthcare Provider Details

I. General information

NPI: 1194688739
Provider Name (Legal Business Name): TIMOTHY WILLIAM WALROD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 CLARKSVILLE RD
FOLSOM CA
95630-8209
US

IV. Provider business mailing address

3675 T ST APT 136
SACRAMENTO CA
95816-6665
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-8868
  • Fax:
Mailing address:
  • Phone: 916-983-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: