Individual
MR. ALVIN WALSH III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
12330 ASHLEY DR, GULFPORT, MS 39503-2737
(228) 832-9038
(228) 832-9990
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
(228) 497-8869
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
901904
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06082764
—
MS
01
—
575390YXF9
MEDICARE PTAN
MS
01
—
901904
STATE LICENSE NUMBER
MS
Enumeration date
02/22/2017
Last updated
12/20/2022
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