Provider Demographics
NPI:1053939215
Name:WALSH, KATIE ROCHELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ROCHELLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ROCHELLE
Other - Last Name:WIDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:7744 CONNER RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3509
Practice Address - Country:US
Practice Address - Phone:865-546-9751
Practice Address - Fax:833-908-2167
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000177266163W00000X
TN29659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse