MEDICARE: TAMARA KAY FUTRELL MS,RD,LD,CNSC,CCTD

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	DT07671	TX

General Provider Information

NPI Number	:	1316832942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA KAY FUTRELL MS,RD,LD,CNSC,CCTD

Provider Business Mailing Address
First Line	:	6113 GILLISPIE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-5053
Country	:	US
Telephone Number	:	817-706-5573
Fax Number	:	817-706-5573

Provider Business Practice Location Address
First Line	:	6113 GILLISPIE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-5053
Country	:	US
Telephone Number	:	817-706-5573
Fax Number	:	817-706-5573

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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