Provider Demographics
NPI:1669545281
Name:WALSH, THERESA ANN (PA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2516 HOSPITALITY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-0216
Mailing Address - Country:US
Mailing Address - Phone:931-489-0045
Mailing Address - Fax:931-489-0087
Practice Address - Street 1:2516 HOSPITALITY LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-0216
Practice Address - Country:US
Practice Address - Phone:931-489-0045
Practice Address - Fax:931-489-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2022-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNPA0000004446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant