Individual
MRS. LINDA BACON WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
4122 BRADFORD LN, JOHNSON CITY, TN 37601-1065
(423) 262-0462
(423) 431-6060
Mailing address
4122 BRADFORD LN, JOHNSON CITY, TN 37601-1065
(423) 262-0462
(423) 431-6060
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDN0000001309
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00B29
—
TN
Enumeration date
02/06/2007
Last updated
07/09/2007
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