Provider Demographics
NPI:1609758523
Name:WESTERCAMP, TARRAH
Entity type:Individual
Prefix:
First Name:TARRAH
Middle Name:
Last Name:WESTERCAMP
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3000
Mailing Address - Country:US
Mailing Address - Phone:765-265-3401
Mailing Address - Fax:
Practice Address - Street 1:848 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3000
Practice Address - Country:US
Practice Address - Phone:765-265-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1109038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered