MEDICARE: COURTNEY BETSILL RD

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	DT86127	TX

General Provider Information

NPI Number	:	1467234997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BETSILL RD

Provider Business Mailing Address
First Line	:	2841 ANDESITE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-2169
Country	:	US
Telephone Number	:	817-694-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	2841 ANDESITE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76108-2169
Country	:	US
Telephone Number	:	817-694-2414
Fax Number	:

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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