Provider Demographics
NPI:1548766926
Name:WALSH, KELLEN O'NEILL (MD)
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:O'NEILL
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16909 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1521
Mailing Address - Country:US
Mailing Address - Phone:402-955-7575
Mailing Address - Fax:402-955-7555
Practice Address - Street 1:16909 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1521
Practice Address - Country:US
Practice Address - Phone:402-955-7575
Practice Address - Fax:402-955-7555
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE33586208000000X
MO2018018197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics