Alyssa Reau Broadwater, MS, RD, LD, CSCS

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

8024 Issued in OH

Practice address

4353 Tuller Rd Ste K
Dublin, OH 43017-5071

Phone

(937) 642-9037

NPI assigned

Aug 9, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Willow Health and Performance

  • Registered Dietitian
  • Dublin, OH
  • NPI 1134731789

  Dietitian, Registered

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597622400000",
    "number": "1063966984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 KENNY LN",
            "city": "CARDINGTON",
            "state": "OH",
            "postal_code": "433159611",
            "telephone_number": "937-642-9037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4353 TULLER RD STE K",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430175071",
            "telephone_number": "937-642-9037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "ALYSSA",
        "middle_name": "REAU",
        "credential": "MS, RD, LD, CSCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-09",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OH",
            "license": "8024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard L Briggs, DC
• Benjamin Vincent Bring, D.O.
• Samir Britel
• Alexis Britford, ATC
• Delesa R Broadnax
• Tiffany Brockett, PHARMD
• Jennifer Lynn Brockmeyer, CNP
• Courtney Brodkorb
• Annmarie Kovach Brogan-Dewitt
• Kaylee Brogan

• Registered Dietitian in Dublin, OH
• Providers in Dublin, OH by specialty
• Registered Dietitian in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.