Provider Demographics
NPI:1285704130
Name:HAMILTON, TAMMY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4043
Mailing Address - Country:US
Mailing Address - Phone:314-359-9165
Mailing Address - Fax:
Practice Address - Street 1:3618 FRENCH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-4043
Practice Address - Country:US
Practice Address - Phone:314-359-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001002198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO356003103Medicaid
MO356003103Medicaid