Provider Demographics
NPI:1023822434
Name:TUBBLEVILLE, TAMMY LYNN (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:TUBBLEVILLE
Suffix:
Gender:
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 STATE HIGHWAY 43 E
Mailing Address - Street 2:
Mailing Address - City:TATUM
Mailing Address - State:TX
Mailing Address - Zip Code:75691-4763
Mailing Address - Country:US
Mailing Address - Phone:903-918-4181
Mailing Address - Fax:
Practice Address - Street 1:13460 STATE HIGHWAY 43 E
Practice Address - Street 2:
Practice Address - City:TATUM
Practice Address - State:TX
Practice Address - Zip Code:75691-4763
Practice Address - Country:US
Practice Address - Phone:903-918-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered