Healthcare Provider Details

I. General information

NPI: 1790699791
Provider Name (Legal Business Name): MADISON HEDGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 LINDA LN
CENTERTON AR
72719-3013
US

IV. Provider business mailing address

431 LINDA LN
CENTERTON AR
72719-3013
US

V. Phone/Fax

Practice location:
  • Phone: 417-661-1965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number2019002120
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: