MEDICARE: MS. LISA BLACKMAN M.S., R.D., L.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT82754	TX

General Provider Information

NPI Number	:	1285070045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA BLACKMAN M.S., R.D., L.D

Provider Business Mailing Address
First Line	:	501 RITA LN STE 113
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2010
Country	:	US
Telephone Number	:	817-468-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 RITA LN STE 113
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2010
Country	:	US
Telephone Number	:	817-468-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	06/30/2015

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