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General NPI Number Information
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NPI Number | 1013434927
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Entity Type | Individual
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Provider Name | KELLY ANN WALSH
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Gender | Female
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 317 E 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-4974
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Country | US
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Telephone | 732-379-1237
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Fax |
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Provider Business Mailing Address
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Address Line | 72 OLD RD
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City | SEWAREN
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State | NJ
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Zip | 07077-1242
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Country | US
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Telephone | 732-379-1237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ01327700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F308267-1
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License Number State | NY
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