Provider Demographics
NPI:1447886957
Name:WALSH, JESSICA (PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CONGRESSIONAL BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5644
Mailing Address - Country:US
Mailing Address - Phone:317-886-8118
Mailing Address - Fax:414-240-2801
Practice Address - Street 1:550 CONGRESSIONAL BLVD STE 115
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5644
Practice Address - Country:US
Practice Address - Phone:317-886-8118
Practice Address - Fax:414-240-2801
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009969A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health