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General NPI Number Information
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NPI Number | 1144183286
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Entity Type | Individual
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Provider Name | CAITLIN WALSH
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Gender |
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 600 JACKSON ST STE B
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-2646
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Country | US
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Telephone | 440-600-8983
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Fax |
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Provider Business Mailing Address
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Address Line | 600 JACKSON ST STE B
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-2646
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Country | US
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Telephone | 440-600-8983
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024195005
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License Number State | VA
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