MEDICARE: TIMOTHY MICHAEL WALSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024180507	VA

General Provider Information

NPI Number	:	1659940583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY MICHAEL WALSH

Provider Business Mailing Address
First Line	:	5309 COMMONWEALTH CENTRE PKWY STE 401
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2633
Country	:	US
Telephone Number	:	804-465-9311
Fax Number	:	804-953-9815

Provider Business Practice Location Address
First Line	:	5309 COMMONWEALTH CENTRE PKWY STE 401
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2633
Country	:	US
Telephone Number	:	804-465-9311
Fax Number	:	804-953-9815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	11/14/2025

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