Provider Demographics
NPI:1144239898
Name:HARGETT, TAMARA M (RD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:HARGETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60493
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76906-0493
Mailing Address - Country:US
Mailing Address - Phone:325-651-2104
Mailing Address - Fax:877-320-9707
Practice Address - Street 1:301 W BEAUREGARD AVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6370
Practice Address - Country:US
Practice Address - Phone:325-651-2104
Practice Address - Fax:877-320-9707
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09520213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803193OtherCERTIFIED DIETETIC REG.
TXDT06818OtherDIETITION LICENSE
TXBCBSOther0095KM
TXBCBSOther0095KM