Healthcare Provider Details

I. General information

NPI: 1477499523
Provider Name (Legal Business Name): MADELYN DOUGLAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 3000
KANSAS CITY MO
64111-5928
US

IV. Provider business mailing address

514 NW WARD RD
LEES SUMMIT MO
64063-1871
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2026006731
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: