Individual provider Active NPI

Marie Kathleen Walsh, DDS

  • General Practice Dentistry
  • West Memphis, AR
National Provider Identifier
1487282760
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4697 Issued in AR
Practice address
900 N 7TH St
West Memphis, AR 72301-2001
Phone
(870) 735-3842
Fax
(870) 394-4817
NPI assigned
Mar 31, 2020
Last updated
Sep 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11370 TN
General Practice Dentistry 1223G0001X 4183-21 MS
General Practice Dentistry 1223G0001X 4697 AR Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

900 N 7TH St
West Memphis, AR 72301-2001

Mailing address

900 N 7TH St
West Memphis, AR 72301-2001
Phone (707) 353-8428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230908002742 AR Order and Referring Only - DentistPractitioner - Dentist 5092139865

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11370TNMDSocial Worker
4697ARMDGeneral Practice Dentistry
4183-21MSMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695254400000",
    "number": "1487282760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N 7TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723012001",
            "telephone_number": "707-353-8428",
            "fax_number": "870-394-4817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N 7TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723012001",
            "telephone_number": "870-735-3842",
            "fax_number": "870-394-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "MARIE",
        "middle_name": "KATHLEEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11370",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4183-21",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "4697",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Memphis, AR

Sources for this page

Verify at the official NPI Registry.