=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548894157
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ROSE WALSH PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2020
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2773 HARRIS ST STE A
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95503-4866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-442-1182
-----------------------------------------------------
Fax | 707-442-1635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2479 WOOD ST
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95501-4758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-918-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | TPA10007
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA61156441
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------