Healthcare Provider Details

I. General information

NPI: 1144188095
Provider Name (Legal Business Name): CALLAWAY PALK RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 CREEK TRAIL LN APT 619
CORNELIUS NC
28031-6557
US

IV. Provider business mailing address

1032 TABARD LN
MATTHEWS NC
28104-8059
US

V. Phone/Fax

Practice location:
  • Phone: 615-806-1847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: