Healthcare Provider Details

I. General information

NPI: 1144183286
Provider Name (Legal Business Name): CAITLIN WALSH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JACKSON ST STE B
ROANOKE RAPIDS NC
27870-2646
US

IV. Provider business mailing address

600 JACKSON ST STE B
ROANOKE RAPIDS NC
27870-2646
US

V. Phone/Fax

Practice location:
  • Phone: 440-600-8983
  • Fax:
Mailing address:
  • Phone: 440-600-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024195005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: