Provider Demographics
NPI:1083866966
Name:WALSH, SARAH R (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:WALSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2121 NORTH LOCUST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4454
Mailing Address - Country:US
Mailing Address - Phone:931-762-5988
Mailing Address - Fax:931-762-3389
Practice Address - Street 1:2121 NORTH LOCUST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4454
Practice Address - Country:US
Practice Address - Phone:931-762-5988
Practice Address - Fax:931-762-3389
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13710363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508693Medicaid