Provider Demographics
NPI:1275058703
Name:WALKER, CARLY (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1111
Mailing Address - Country:US
Mailing Address - Phone:508-942-7756
Mailing Address - Fax:
Practice Address - Street 1:251 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1111
Practice Address - Country:US
Practice Address - Phone:508-942-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4249133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered