Provider Demographics
NPI:1467170860
Name:LAWLEY, TARA LYNN (RD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:LAWLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 ROXANNE ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4250
Mailing Address - Country:US
Mailing Address - Phone:325-514-6001
Mailing Address - Fax:
Practice Address - Street 1:307 ROXANNE ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4250
Practice Address - Country:US
Practice Address - Phone:325-514-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered