Healthcare Provider Details

I. General information

NPI: 1740199090
Provider Name (Legal Business Name): BROOKE H. PEARSON MPH, RDN, CSSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 TRAILHEAD DR APT 205
CROZET VA
22932-3439
US

IV. Provider business mailing address

4570 TRAILHEAD DR APT 205
CROZET VA
22932-3439
US

V. Phone/Fax

Practice location:
  • Phone: 317-650-8877
  • Fax:
Mailing address:
  • Phone: 317-650-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: