Active NPI
Amanda Marcella Allen, MS, RDN, LD
- Registered Dietitian
- Springfield, MO
National Provider Identifier
1891296554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2016030257
- Practice address
- 1720 W Battlefield St
Springfield, MO 65807-5359 - Phone
- (417) 881-1950
- Fax
- (417) 881-8289
- NPI assigned
- Feb 27, 2018
- 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 | 2016030257 | MO | Primary |
Addresses
Primary practice location
1720 W Battlefield St
Springfield, MO 65807-5359
Mailing address
1720 W Battlefield St
Springfield, MO 65807-5359
Phone (417) 881-1950
Other names 1
- Ms. Amanda Marcella Broombaugh
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016030257 | MO | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
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": "1519689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519689600000",
"number": "1891296554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 W BATTLEFIELD ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658075359",
"telephone_number": "417-881-1950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 W BATTLEFIELD ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658075359",
"telephone_number": "417-881-1950",
"fax_number": "417-881-8289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "AMANDA",
"middle_name": "MARCELLA",
"name_prefix": "Mrs.",
"credential": "MS, RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-27",
"last_updated": "2018-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2016030257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "BROOMBAUGH",
"middle_name": "MARCELLA",
"prefix": "MS.",
"credential": "MS, RDN, LD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.