MEDICARE: MADELINE THOMAS NUTRITION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1669338588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADELINE THOMAS NUTRITION, LLC

Provider Business Mailing Address
First Line	:	3803 DUVAL ST APT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-5123
Country	:	US
Telephone Number	:	512-956-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	3803 DUVAL ST APT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-5123
Country	:	US
Telephone Number	:	512-956-6024
Fax Number	:

Authorized Official
Title or Position	:	OWNER/REGISTERED DIETITIAN
Name	:	MADELINE THOMAS
Credential	:	RD
Telephone Number	:	512-956-6024

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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