Provider Demographics
NPI:1194367011
Name:WILCOX, SARAH (RD, LD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SAINT CLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2260
Mailing Address - Country:US
Mailing Address - Phone:940-453-1333
Mailing Address - Fax:
Practice Address - Street 1:2205 SAINT CLAIRE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2260
Practice Address - Country:US
Practice Address - Phone:940-453-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82399133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82399OtherTDLR
TX1014520OtherCOMMISSION ON DIETETIC REGISTRATION