Healthcare Provider Details

I. General information

NPI: 1285479329
Provider Name (Legal Business Name): MADELINE LEE THRASHER MSN, APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

5806 BEVERLY AVE
MISSION KS
66202-2605
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-5636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number53-83328-072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: