Healthcare Provider Details

I. General information

NPI: 1093664567
Provider Name (Legal Business Name): MADELINE LEEANN MCLAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 NE INDEPENDENCE AVE STE 201
LEES SUMMIT MO
64064-2379
US

IV. Provider business mailing address

5916 S NETTLETON AVE
SPRINGFIELD MO
65810-2774
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: