Emma Louise Wicks, MS RD LD CIEC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2021038178 Issued in MO

Practice address

1905 Cherry Hill Dr Ste 300
Columbia, MO 65203-5812

Phone

(573) 343-4017

Fax

(573) 615-4443

NPI assigned

Nov 19, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bamboo Nutrition, LLC

  • Registered Dietitian
  • Columbia, MO
  • NPI 1639795727

  Dietitian, Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1699432096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5198 WADDELL HOLLOW RD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370649433",
            "telephone_number": "615-305-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CHERRY HILL DR STE 300",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035812",
            "telephone_number": "573-343-4017",
            "fax_number": "573-615-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKS",
        "first_name": "EMMA",
        "middle_name": "LOUISE",
        "credential": "MS RD LD CIEC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TN",
            "license": "4152",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "5324",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2021038178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Catherine Whittom
• Shawn Michael Whitton, MD
• Lloyd Wayne Whyte, MSW LCSW MO LICENSE
• Mikayla Leighann Wichern, LMSW
• Wicks Chiropractic, LLC
• Tyler Rhea Wicks, D.C.
• Andrea Elizabeth Wiele, MS
• Mary S Wiemer, AHCNS
• Mark Edward Wienke, R.PH., CGP
• Natalie Brooke Wier, RDMS, RVT

• Registered Dietitian in Columbia, MO
• Providers in Columbia, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.