Provider Demographics
NPI:1316832942
Name:FUTRELL, TAMARA KAY (MS,RD,LD,CNSC,CCTD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:MS,RD,LD,CNSC,CCTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 GILLISPIE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-5053
Mailing Address - Country:US
Mailing Address - Phone:817-706-5573
Mailing Address - Fax:817-706-5573
Practice Address - Street 1:6113 GILLISPIE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-5053
Practice Address - Country:US
Practice Address - Phone:817-706-5573
Practice Address - Fax:817-706-5573
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07671133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered