Provider Demographics
NPI:1194503219
Name:TAMMY BEASLEY NUTRITION LLC
Entity type:Organization
Organization Name:TAMMY BEASLEY NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CEDS-C
Authorized Official - Phone:256-682-2301
Mailing Address - Street 1:3011 BASSWOOD WAY SE
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35741-9391
Mailing Address - Country:US
Mailing Address - Phone:256-682-2301
Mailing Address - Fax:205-431-3409
Practice Address - Street 1:3011 BASSWOOD WAY SE
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-9391
Practice Address - Country:US
Practice Address - Phone:256-682-2301
Practice Address - Fax:205-431-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty