Provider Demographics
NPI:1386949568
Name:ELMORE, CHRISTINA WALKER (RD,)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:WALKER
Last Name:ELMORE
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 1:206 HANES MILL RD
Mailing Address - Street 2:
Mailing Address - City:ST MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-8715
Mailing Address - Country:US
Mailing Address - Phone:803-606-2515
Mailing Address - Fax:
Practice Address - Street 1:206 HANES MILL RD
Practice Address - Street 2:
Practice Address - City:ST MATTHEWS
Practice Address - State:SC
Practice Address - Zip Code:29135-8715
Practice Address - Country:US
Practice Address - Phone:803-606-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered