Tamra Lei Boteler
Individual provider Active NPI Pediatric Nutrition Registered Dietitian · Midlothian, TX
NPI 1194075762 · NPPES record last updated Apr 7, 2014
Key facts
- NPI
- 1194075762
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nutrition Registered Dietitian 133VN1004X
- License
- DT81661 (TX)
- Practice address
- 4440 E Highway 287
Midlothian, TX 76065-5576 - Phone
- (972) 723-5590
- NPI assigned
- Sep 11, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT81661 | TX | MD | Pediatric Nutrition Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | |||
| Pediatric Nutrition Registered Dietitian | 133VN1004X | DT81661 | TX | Yes |
Addresses
Primary practice location
4440 E Highway 287
Midlothian, TX 76065-5576
Mailing address
4440 E Highway 287
Midlothian, TX 76065-5576
Phone (972) 723-5590
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207164901 | Medicaid | TX | |
| 149984001 | Medicaid | TX |
Other providers in Midlothian, TX
- Dereke Bogier
- Kristen Michelle Bold
- Melissa Boler
- Ella Bonfiglio
- Sheree Lanette Booker
- Brad Wesley Collins DC PA
- Cersten Bradley
- Bridges Training Foundation
- Brandy Michelle Brinkley
- Bobby Allen Brite
All providers in Midlothian, TX · Pediatric Nutrition Registered Dietitian in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.