Provider Demographics
NPI:1497213060
Name:RICHARS, MADISON POWELL (MS, RD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:POWELL
Last Name:RICHARS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 N 25TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7427
Mailing Address - Country:US
Mailing Address - Phone:918-629-1159
Mailing Address - Fax:
Practice Address - Street 1:3315 N 25TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7427
Practice Address - Country:US
Practice Address - Phone:918-629-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86049625133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86049625OtherCOMMISSION ON DIETETIC REGISTRATION