Provider Demographics
NPI:1043532146
Name:WALTERS, MELINDA (RD)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:WALTERS
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 1:3641 S 2640 E
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4978
Mailing Address - Country:US
Mailing Address - Phone:801-372-6712
Mailing Address - Fax:
Practice Address - Street 1:3641 S 2640 E
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4978
Practice Address - Country:US
Practice Address - Phone:801-372-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4890304-4901133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal