Active NPI
Roberta Kindal Woodruff, RDN, LD
- Registered Dietitian
- Miramar Beach, FL
National Provider Identifier
1841653201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND7682
- Practice address
- 495 Grand Blvd
Suite 206
Miramar Beach, FL 32550-1897 - Phone
- (770) 940-4013
- Fax
- (850) 361-3364
- NPI assigned
- Apr 3, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND7682 | FL | Primary |
Addresses
Primary practice location
495 Grand Blvd
Suite 206
Miramar Beach, FL 32550-1897
Mailing address
495 Grand Blvd
Suite 206
Miramar Beach, FL 32550-1897
Phone (770) 940-4013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND7682 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459641600000",
"number": "1841653201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "495 GRAND BLVD",
"address_2": "SUITE 206",
"city": "MIRAMAR BEACH",
"state": "FL",
"postal_code": "325501897",
"telephone_number": "770-940-4013",
"fax_number": "850-361-3364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "495 GRAND BLVD",
"address_2": "SUITE 206",
"city": "MIRAMAR BEACH",
"state": "FL",
"postal_code": "325501897",
"telephone_number": "770-940-4013",
"fax_number": "850-361-3364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODRUFF",
"first_name": "ROBERTA",
"middle_name": "KINDAL",
"name_prefix": "Ms.",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-03",
"last_updated": "2016-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND7682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miramar Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.