Healthcare Provider Details

I. General information

NPI: 1730095456
Provider Name (Legal Business Name): KAITLYN NOEL WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 114TH AVE SE STE 203
BELLEVUE WA
98004-6906
US

IV. Provider business mailing address

1715 114TH AVE SE STE 203
BELLEVUE WA
98004-6906
US

V. Phone/Fax

Practice location:
  • Phone: 206-317-8287
  • Fax:
Mailing address:
  • Phone: 206-317-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: