Provider Demographics
NPI:1285282988
Name:WILCOX, MADELYN (RD, CSO)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:WILCOX
Suffix:
Gender:
Credentials:RD, CSO
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:
Other - Last Name:DRUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CSO
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:3850 S NATIONAL AVE STE 600
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5230
Practice Address - Country:US
Practice Address - Phone:417-882-4880
Practice Address - Fax:417-882-7843
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86001617133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI86001617OtherCOMMISSION ON DIETETIC REGISTRATION