Provider Demographics
NPI:1780077586
Name:WALKER, MARY (RD, LD/N)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 MERRY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3665
Mailing Address - Country:US
Mailing Address - Phone:850-284-9472
Mailing Address - Fax:850-562-4042
Practice Address - Street 1:1550 MERRY OAKS CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3665
Practice Address - Country:US
Practice Address - Phone:850-284-9472
Practice Address - Fax:850-562-4042
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5442133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered