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General NPI Number Information
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NPI Number | 1598021321
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Entity Type | Individual
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Provider Name | PAMELA LYNN WALSH NP
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Gender | Female
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 2133 WELSH DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-4875
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Country | US
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Telephone | 636-262-5826
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Fax |
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Provider Business Mailing Address
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Address Line | 1252 WOODGROVE PARK DR
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City | O FALLON
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State | MO
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Zip | 63366-1584
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Country | US
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Telephone | 636-262-5826
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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 | 113048
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License Number State | MO
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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 | 209012610
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9338452
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License Number State | FL
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