Healthcare Provider Details

I. General information

NPI: 1760343669
Provider Name (Legal Business Name): MAKAYLA GRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2372 S MARLBOROUGH AVE
SPRINGFIELD MO
65807-8634
US

IV. Provider business mailing address

2372 S MARLBOROUGH AVE
SPRINGFIELD MO
65807-8634
US

V. Phone/Fax

Practice location:
  • Phone: 417-297-1528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020002392
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: