Amanda Michelle Walsh, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

1113044 Issued in TX

Practice address

510 E Commerce St
Jacksonville, TX 75766-4910

Phone

(903) 535-9041

NPI assigned

Mar 14, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awalsh309215@christushealth.direct-ci.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tyler Family Circle of Care

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
  • NPI 1144575820

  TX

  Medicare reassignment NPD
• Tyler Family Circle of Care

  • Community/Retail Pharmacy
  • Tyler, TX
  • NPI 1942011903
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1003517244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 COUNTY ROAD 783",
            "city": "DOUGLASS",
            "state": "TX",
            "postal_code": "759434240",
            "telephone_number": "936-205-6353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E COMMERCE ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757664910",
            "telephone_number": "903-535-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "AMANDA",
        "middle_name": "MICHELLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-14",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "807548",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "1113044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Sorrell Wade, LPC
• Wal-Mart Stores Texas LLC
• Wal-Mart Stores Texas, LP
• Walgreen Co
• Walgreen Co
• Andre Joseph Ward, FNP
• Austin A Weaver, MD
• Craig C Weaver, MD
• Kent P Webb, MD
• Susan Carol West Jan, MOT

• All providers in Jacksonville, TX
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.