Healthcare Provider Details

I. General information

NPI: 1679059596
Provider Name (Legal Business Name): JARED WALSH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33003 GREENFIELD FOREST DR
MAGNOLIA TX
77354-2594
US

IV. Provider business mailing address

10325 CYPRESSWOOD DR
HOUSTON TX
77070-3416
US

V. Phone/Fax

Practice location:
  • Phone: 281-682-6082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number920795
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: