Active NPI
Katelynn Marie Walsh, MS, LAT, ATC, EMT
- Athletic Trainer
- Waconia, MN
National Provider Identifier
1003479965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 3359
- Practice address
- 560 S Maple St
Waconia, MN 55387-1733 - Phone
- (952) 843-8505
- NPI assigned
- Apr 17, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | 3359 | MN | Primary |
Addresses
Primary practice location
560 S Maple St
Waconia, MN 55387-1733
Mailing address
PO Box 282
Carver, MN 55315-0282
Phone (952) 843-8505
Other practice location 1
8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3359 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679529600000",
"number": "1003479965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 282",
"city": "CARVER",
"state": "MN",
"postal_code": "553150282",
"telephone_number": "952-843-8505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 S MAPLE ST",
"city": "WACONIA",
"state": "MN",
"postal_code": "553871733",
"telephone_number": "952-843-8505"
}
],
"practiceLocations": [
{
"address_1": "8100 Northland Dr",
"address_purpose": "LOCATION",
"city": "Bloomington",
"state": "MN",
"postal_code": "554314800",
"country_code": "US",
"telephone_number": "952-831-8742",
"fax_number": "952-806-5473",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALSH",
"first_name": "KATELYNN",
"middle_name": "MARIE",
"credential": "MS, LAT, ATC, EMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-17",
"last_updated": "2023-03-23",
"certification_date": "2023-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "3359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.