Provider Demographics
NPI:1447949326
Name:BEASLEY, TAMMY MICHELE (MS RDN CEDS-S)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MICHELE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MS RDN CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered