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General NPI Number Information
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NPI Number | 1285282988
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Entity Type | Individual
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Provider Name | MADELYN WILCOX RD, CSO
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Gender | Female
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 3850 S NATIONAL AVE STE 600
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5230
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Country | US
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Telephone | 417-882-4880
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Fax | 417-882-7843
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Provider Business Mailing Address
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Address Line | PO BOX 749495
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City | ATLANTA
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State | GA
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Zip | 30374-9495
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Country | US
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Telephone | 855-963-2100
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Fax | 813-321-1296
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86001617
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License Number State | MI
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