Provider Demographics
NPI:1790835601
Name:WALKER, ELIZABETH A (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:204 MEDICAL DRIVE
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-0378
Mailing Address - Country:US
Mailing Address - Phone:931-528-8153
Mailing Address - Fax:615-666-7002
Practice Address - Street 1:204 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1719
Practice Address - Country:US
Practice Address - Phone:615-666-2147
Practice Address - Fax:615-666-7002
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered