Healthcare Provider Details

I. General information

NPI: 1235054248
Provider Name (Legal Business Name): MADISON COLLARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W ADAMS ST
BOWLING GREEN MO
63334-1974
US

IV. Provider business mailing address

1015 W ADAMS ST
BOWLING GREEN MO
63334-1974
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-5300
  • Fax:
Mailing address:
  • Phone: 573-324-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026038616
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: