Individual
MADELYN WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CSO
Contact information
Practice address
3850 S NATIONAL AVE STE 600, SPRINGFIELD, MO 65807-5230
(417) 882-4880
(417) 882-7843
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(855) 963-2100
(813) 321-1296
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
2022002479
MO
133V00000X
Registered Dietitian
2363
AR
133V00000X
Registered Dietitian
3849
KS
133V00000X
Registered Dietitian
Primary
86001617
MI
133V00000X
Registered Dietitian
D-1420
ID
133V00000X
Registered Dietitian
DT89624
TX
133V00000X
Registered Dietitian
LD-D-10251697
OR
133V00000X
Registered Dietitian
LD.09640
OH
133V00000X
Registered Dietitian
LD004819
GA
133V00000X
Registered Dietitian
ND10243
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86001617
COMMISSION ON DIETETIC REGISTRATION
MI
Enumeration date
08/27/2019
Last updated
04/02/2026
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