Healthcare Provider Details

I. General information

NPI: 1205741527
Provider Name (Legal Business Name): MADILYNE BROOK PEEBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

1810 CAROLINE AVE APT R004
JUNCTION CITY KS
66441-5330
US

V. Phone/Fax

Practice location:
  • Phone: 785-240-7410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH.0010371-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: