Provider Demographics
NPI:1396370144
Name:WALKER, JAMIE (RDN,LD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RDN,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4170
Mailing Address - Country:US
Mailing Address - Phone:440-701-7535
Mailing Address - Fax:440-701-7543
Practice Address - Street 1:8655 MARKET ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4170
Practice Address - Country:US
Practice Address - Phone:440-701-7535
Practice Address - Fax:440-701-7543
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered