Provider Demographics
NPI:1487429536
Name:MASONCUP, JODI LEE (RDN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LEE
Last Name:MASONCUP
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:VIAR
Other - Last Name:MASONCUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:1600 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4300
Mailing Address - Country:US
Mailing Address - Phone:940-764-3139
Mailing Address - Fax:
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3430
Practice Address - Country:US
Practice Address - Phone:940-676-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered