Provider Demographics
NPI:1649915836
Name:OVERETT, ALYSSA L (MS, RD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:OVERETT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:L
Other - Last Name:OVERETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, RD
Mailing Address - Street 1:8440 WOODFIELD CROSSING BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4359
Mailing Address - Country:US
Mailing Address - Phone:463-800-6977
Mailing Address - Fax:
Practice Address - Street 1:8440 WOODFIELD CROSSING BLVD STE 175
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4359
Practice Address - Country:US
Practice Address - Phone:463-800-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered