Healthcare Provider Details

I. General information

NPI: 1962367664
Provider Name (Legal Business Name): MADISON CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E RED BRIDGE RD STE 207
KANSAS CITY MO
64131-4030
US

IV. Provider business mailing address

12401 W 119TH PL APT 1327
OVERLAND PARK KS
66213-5743
US

V. Phone/Fax

Practice location:
  • Phone: 913-681-2398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5385070012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: