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General NPI Number Information
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NPI Number | 1023060142
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Entity Type | Individual
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Provider Name | CRISTY JANESE WALSH CNM
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 42121 US HIGHWAY 70
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City | PORTALES
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State | NM
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Zip | 88130-9054
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Country | US
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Telephone | 575-356-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 W 21ST ST STE A-1
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City | CLOVIS
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State | NM
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Zip | 88101-4087
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Country | US
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Telephone | 575-762-8055
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Fax | 575-763-3351
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 448
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License Number State | NM
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