Provider Demographics
NPI:1912359647
Name:WALSH, DEIRDRE (PA)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:RHOADS
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6511
Mailing Address - Country:US
Mailing Address - Phone:615-515-1900
Mailing Address - Fax:
Practice Address - Street 1:2400 PATTERSON ST STE 502
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6511
Practice Address - Country:US
Practice Address - Phone:615-515-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008012363A00000X
TN4169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant