Individual provider Active NPI

Katie Rochelle Walsh, FNP

  • Family Nurse Practitioner
  • Powell, TN
National Provider Identifier
1053939215
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
29659 Issued in TN
Practice address
7744 Conner Rd
Powell, TN 37849-3509
Phone
(865) 546-9751
Fax
(833) 908-2167
NPI assigned
Jul 13, 2020
Last updated
Jul 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN0000177266 TN
Family Nurse Practitioner 363LF0000X 29659 TN Primary

Addresses

Primary practice location

7744 Conner Rd
Powell, TN 37849-3509

Mailing address

1275 Dick Lonas Rd Unit 101
Knoxville, TN 37909-1383
Phone (865) 584-4747

Other names 1

  • Katie Rochelle Widick Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20210727003699 TN Practitioner - Nurse Practitioner 5698178705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Lincoln Memorial University Medical Department, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group, PLLCGroup PAC ID 2860396330, 636 clinicians

Practice addresses (Care Compare)

7744 Conner Rd
Powell, TN 37849-3509
Phone (865) 546-9751

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN0000177266TNMDRegistered Nurse
29659TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, PLLC CurrentSince Jul 1, 2021 Accepting new patients
Summit Medical Group, PLLC CurrentSince Jul 1, 2021 Accepting new patients
Summit Medical Group PLLC PastSince Mar 24, 2024 Accepting new patients
Summit Medical Group,PLLC Past Accepting new patients
Summit Medical Group, PLLC Past Accepting new patients

Locations

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

1275 Dick Lonas Rd
Unit 101
Knoxville, TN 37909

7744 Conner Rd
Powell, TN 37849
Phone (865) 546-9751

Interoperability endpoints

  • Direct secure messaging: katie.walsh.1@20785.direct.athenahealth.com

Organizations & group practices 5

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1053939215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD UNIT 101",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091383",
            "telephone_number": "865-584-4747",
            "fax_number": "865-584-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7744 CONNER RD",
            "city": "POWELL",
            "state": "TN",
            "postal_code": "378493509",
            "telephone_number": "865-546-9751",
            "fax_number": "833-908-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "KATIE",
        "middle_name": "ROCHELLE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-13",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN0000177266",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "29659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "WIDICK",
            "middle_name": "ROCHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Powell, TN

Sources for this page

Verify at the official NPI Registry.