Healthcare Provider Details

I. General information

NPI: 1851934491
Provider Name (Legal Business Name): KAITLIN MARIE WALSH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 S FAYETTEVILLE ST
ASHEBORO NC
27203-6667
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-2467
  • Fax: 336-625-2256
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number024357
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: