Healthcare Provider Details

I. General information

NPI: 1205780681
Provider Name (Legal Business Name): MADISON PAIGE STEPHENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 S SOUTHWOOD RD
SPRINGFIELD MO
65804-5234
US

IV. Provider business mailing address

3080 E CHERRY ST APT E320
SPRINGFIELD MO
65802-4194
US

V. Phone/Fax

Practice location:
  • Phone: 417-227-9000
  • Fax:
Mailing address:
  • Phone: 417-718-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2026005708
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: