Provider Demographics
NPI:1952342909
Name:WALSON, STELLA OZOH (FNP/PMHNP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:OZOH
Last Name:WALSON
Suffix:
Gender:F
Credentials:FNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-277-1800
Mailing Address - Fax:336-277-6981
Practice Address - Street 1:175 KIMEL PARK DR
Practice Address - Street 2:STE 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6951
Practice Address - Country:US
Practice Address - Phone:336-277-1800
Practice Address - Fax:336-277-6981
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5002035363L00000X, 363LP0808X
NC0050-02035363LF0000X
VA0024166959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003836Medicaid
VA010286000Medicaid
VA010635D35Medicare PIN
NC2592818Medicare PIN
VA010286000Medicaid