Basic Information
| Provider Information | |||||||||
| NPI: | 1720615933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 HOOK RD UNIT 31 | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126017301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452425577 | ||||||||
| FaxNumber: | 8454833845 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 OLD ORANGEBURG RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109621157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
| FaxNumber: | 8453593143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2020 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 634329 | NY | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.