Individual provider Active NPI

Alyssa Ann Moore, RD

  • Registered Dietitian
  • Dallas, TX
National Provider Identifier
1609686047
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DT91731 Issued in TX
Practice address
17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905
Phone
(469) 372-2022
Fax
(833) 290-5413
NPI assigned
Jan 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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 DT91731 TX Primary

Addresses

Primary practice location

17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905

Mailing address

17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250417001121 TX Practitioner - Registered Dietitian Or Nutrition Professional 5991220428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Doherty Nutrition LLCGroup PAC ID 0941610273, 16 clinicians

Practice addresses (Care Compare)

17060 Dallas Pkwy
Suite 112
Dallas, TX 75248-1905
Phone (469) 372-2022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DT91731TXMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Doherty Nutrition LLC Dietitian, Registered CurrentSince Feb 14, 2025 Accepting new patients

Locations

17060 Dallas Pkwy
Ste 112
Dallas, TX 75248
Phone (469) 372-2022

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1609686047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17060 DALLAS PKWY STE 112",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17060 DALLAS PKWY STE 112",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481905",
            "telephone_number": "469-372-2022",
            "fax_number": "833-290-5413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ALYSSA",
        "middle_name": "ANN",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT91731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.