Provider Demographics
NPI:1346693512
Name:WALKER, RITA G (MS, LDN, RD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:G
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MOSSY OAK DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-4101
Mailing Address - Country:US
Mailing Address - Phone:318-816-9066
Mailing Address - Fax:
Practice Address - Street 1:111 MOSSY OAK DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-4101
Practice Address - Country:US
Practice Address - Phone:318-816-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered