Provider Demographics
NPI:1568044766
Name:ARTMORE, TREMEKER AMANDA
Entity Type:Individual
Prefix:
First Name:TREMEKER
Middle Name:AMANDA
Last Name:ARTMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 FANNIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3804
Mailing Address - Country:US
Mailing Address - Phone:832-815-4411
Mailing Address - Fax:
Practice Address - Street 1:3480 FANNIN ST STE E
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3804
Practice Address - Country:US
Practice Address - Phone:832-815-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
TX
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83-1043436OtherNO MEDICARE
831043436OtherNONE