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General NPI Number Information
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NPI Number | 1629842125
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Entity Type | Individual
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Provider Name | KEVIN PETER WALTON MS, RD, LDN, CNSC
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Gender | Male
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 55 FRUIT ST
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City | BOSTON
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State | MA
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Zip | 02114-2621
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Country | US
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Telephone | 617-726-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 105 SUMMER ST APT 105
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City | MALDEN
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State | MA
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Zip | 02148-2539
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Country | US
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Telephone | 203-804-4127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86068323
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License Number State |
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