Healthcare Provider Details

I. General information

NPI: 1023399573
Provider Name (Legal Business Name): KIERA WALSH BS, CLC, CLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 BEECH HILL RD
SUMMERVILLE SC
29485-7870
US

IV. Provider business mailing address

180 GARDEN LILY LN
SUMMERVILLE SC
29485-9229
US

V. Phone/Fax

Practice location:
  • Phone: 843-640-5379
  • Fax:
Mailing address:
  • Phone: 843-640-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: