Individual provider Active NPI

Christina Bedetta Willett, RD, LDN

  • Registered Dietitian
  • Riverside, RI
National Provider Identifier
1366910374
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
LDN00971 Issued in RI
Practice address
505 Wild Goose Rd Apt 202
Riverside, RI 02915-2682
Phone
(401) 578-4091
NPI assigned
Nov 7, 2018
Last updated
Apr 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X LDN00971 RI Primary

Addresses

Primary practice location

505 Wild Goose Rd Apt 202
Riverside, RI 02915-2682

Mailing address

505 Wild Goose Rd Apt 202
Riverside, RI 02915-2682
Phone (401) 578-4091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181227001363 RI Practitioner - Registered Dietitian Or Nutrition Professional 1759626401 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
LDN00971RIMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Evolution Nutrition Inc. Dietitian, Registered CurrentSince Jan 1, 2019 Accepting new patients
Nourish, Inc. Dietitian, Registered Past Accepting new patients

Locations

450 Veterans Memorial Pkwy
East Providence, RI 02914
Phone (401) 431-0080

450 Veterans Memorial Pkwy
Ste 8C
East Providence, RI 02914
Phone (401) 396-9331

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1366910374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 WILD GOOSE RD APT 202",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152682",
            "telephone_number": "401-578-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 WILD GOOSE RD APT 202",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152682",
            "telephone_number": "401-578-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDETTA WILLETT",
        "first_name": "CHRISTINA",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-07",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "RI",
            "license": "LDN00971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.