Provider Demographics
NPI:1497785695
Name:WALSH, KATHLEEN LUCILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LUCILLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:LUCILLE
Other - Last Name:WALSH-RENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:CLARK CLINIC
Mailing Address - Street 2:BASTOGNE EXTENSION
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-9755
Mailing Address - Fax:910-907-8011
Practice Address - Street 1:CLARK CLINIC
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-977-9755
Practice Address - Fax:910-907-8011
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine