Callan E Wall, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L004679 Issued in NC

Practice address

5405 Carolyn Dr
Wilmington, NC 28409-5913

Phone

(919) 244-8234

Fax

(877) 889-2993

NPI assigned

Jul 31, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1932585957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017507",
            "telephone_number": "910-239-3562",
            "fax_number": "877-889-2993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 CAROLYN DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284095913",
            "telephone_number": "919-244-8234",
            "fax_number": "877-889-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "CALLAN",
        "middle_name": "E",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-31",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L004679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDR",
            "identifier": "86056016",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lee Walker, LCSWA
• Rachel K Walker, DPT
• Renee T Walker, MSW, LCSWA
• Stephen Walker, FNP
• Benjamin Evans Wall, MD
• Renee V. Wall, PA-C
• Brooke Elizabeth Wallace, OTR/L
• Emma B. Wallace, LMFT
• John Wallace II, MD
• Leshonda Tequilla Wallace, FNP

• Registered Dietitian in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Registered Dietitian in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.