Individual
KEIRAN WALSH LLANEZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3125 SPRINGBANK LN, SUITE E, CHARLOTTE, NC 28226-3378
(704) 381-3510
(704) 540-3668
Mailing address
PO BOX 602148, CHARLOTTE, NC 28260-2148
(704) 381-3510
(704) 540-3668
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-00392
NC
363AM0700X
Medical Physician Assistant
100392
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0531PA
—
SC
05
—
1396884219
—
NC
05
—
8102249
—
NC
Enumeration date
02/06/2007
Last updated
04/23/2014
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