MEDICARE: MELISSA LYNNE WILDER MPH, RD, LD

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		TX

General Provider Information

NPI Number	:	1780249938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNNE WILDER MPH, RD, LD

Provider Business Mailing Address
First Line	:	10019 LOCKE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3101
Country	:	US
Telephone Number	:	281-723-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	10019 LOCKE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3101
Country	:	US
Telephone Number	:	281-723-2544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	04/14/2025

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