Provider Demographics
NPI:1154122893
Name:HUNT, TARA HAMBELTON (RD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:HAMBELTON
Last Name:HUNT
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:HAMBELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4160 N STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-3352
Mailing Address - Country:US
Mailing Address - Phone:206-910-9558
Mailing Address - Fax:
Practice Address - Street 1:4160 N STRATFORD DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-3352
Practice Address - Country:US
Practice Address - Phone:206-910-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1012133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty