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General NPI Number Information
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NPI Number | 1427341247
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Entity Type | Individual
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Provider Name | KIMBERLY A WALSH NP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 3931 LOUISIANA AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-5000
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Country | US
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Telephone | 952-993-3248
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Fax |
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Provider Business Mailing Address
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Address Line | 3931 LOUISIANA AVE S
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-5000
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Country | US
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Telephone | 952-993-3248
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R158402-0
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP2078
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License Number State | MN
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