MEDICARE: PARKER WALLACE MCKINNON R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L008750	NC
2	133V00000X	Registered Dietitian	DT88010	TX

General Provider Information

NPI Number	:	1992400352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARKER WALLACE MCKINNON R.D.

Provider Business Mailing Address
First Line	:	800 HARTFORD AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2304
Country	:	US
Telephone Number	:	210-394-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 HARTFORD AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2304
Country	:	US
Telephone Number	:	210-394-7661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	02/10/2026

Similar Medicare Providers

1720105539 — KELLY R CROSS M.S. CCC-SLP
Practice Location Address:

1700 NANTUCKETT LN , #106
CHARLOTTE, NC
28270-2304

Practice Phone: 704-654-6119
Practice Fax: 704-708-9499

1669786737 — MOLLY KASSON CLUNE
Practice Location Address:

2304 GRIMMERSBOROUGH LN
CHARLOTTE, NC
28270-3713

Practice Phone: 704-650-3105
Practice Fax:

1629770490 — ANDREW MCLEAN WHITE MD
Practice Location Address:

4510 BARWICK RD
CHARLOTTE, NC
28211-2304

Practice Phone: 704-617-1681
Practice Fax:

1306798848 — A PATH FORWARD PLLC
Practice Location Address:

5925 CARNEGIE BLVD STE 200
CHARLOTTE, NC
28209-4703

Practice Phone: 980-254-2070
Practice Fax:

1881546240 — JENNIFER GUILLAUME BSN, RN
Practice Location Address:

5126 PARK RD STE 2C
CHARLOTTE, NC
28209-3748

Practice Phone: 704-247-7281
Practice Fax: 704-800-5655

1912413428 — JESSICA DANIELLE KEALA WISE DNP, CNM, PMHNP
Practice Location Address:

4412 PARK RD STE B
CHARLOTTE, NC
28209-3130

Practice Phone: 617-379-0496
Practice Fax:

Directions to “ PARKER WALLACE MCKINNON R.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.