Healthcare Provider Details

I. General information

NPI: 1972587780
Provider Name (Legal Business Name): KATHLEEN J WALSH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 THE VILLAGE OVERLOOK
SYLVA NC
28779-2742
US

IV. Provider business mailing address

70 THE VILLAGE OVERLOOK
SYLVA NC
28779-2742
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-1960
  • Fax: 828-586-3489
Mailing address:
  • Phone: 828-631-1960
  • Fax: 828-586-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5007359
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: