Provider Demographics
NPI:1922481712
Name:WALSH, SEAN PATRICK (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:WALSH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 NORTH CHURCH PLACE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2799
Mailing Address - Country:US
Mailing Address - Phone:864-433-0214
Mailing Address - Fax:
Practice Address - Street 1:2030 NORTH CHURCH PL
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2799
Practice Address - Country:US
Practice Address - Phone:864-234-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily