Provider Demographics
NPI:1164569919
Name:BEEMAN, TRACY L (MS, RD, CSSD, LD)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:BEEMAN
Suffix:
Gender:F
Credentials:MS, RD, CSSD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 RUNNING BRUSH LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4851
Mailing Address - Country:US
Mailing Address - Phone:512-221-7933
Mailing Address - Fax:
Practice Address - Street 1:4210 W BRAKER LN
Practice Address - Street 2:NUTRITION & HEALTH EDUCATION
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5354
Practice Address - Country:US
Practice Address - Phone:512-221-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960928133V00000X
TXDT80671133V00000X
TX960928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered