Provider Demographics
NPI:1619531720
Name:WALSH, JENNIFER (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SHOCKEY/QUIOGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:3000 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1921
Mailing Address - Country:US
Mailing Address - Phone:513-732-8629
Mailing Address - Fax:513-732-8626
Practice Address - Street 1:3000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1921
Practice Address - Country:US
Practice Address - Phone:513-732-8629
Practice Address - Fax:513-732-8626
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1126770363L00000X
KY3013444363L00000X, 363LP0808X
OH0031221363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner