Provider Demographics
NPI:1891510772
Name:WALKER, CARLY CHRISTINE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:CHRISTINE
Last Name:WALKER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NEW ST
Mailing Address - Street 2:
Mailing Address - City:HUGHESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2148
Mailing Address - Country:US
Mailing Address - Phone:484-426-2662
Mailing Address - Fax:
Practice Address - Street 1:889 CHATFIELD RD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2913
Practice Address - Country:US
Practice Address - Phone:215-264-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered