Provider Demographics
NPI:1235483082
Name:THOMAS-WALSH, AVION J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AVION
Middle Name:J
Last Name:THOMAS-WALSH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1800
Mailing Address - Country:US
Mailing Address - Phone:845-672-4020
Mailing Address - Fax:
Practice Address - Street 1:158 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1800
Practice Address - Country:US
Practice Address - Phone:845-672-4420
Practice Address - Fax:949-655-5993
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily