Healthcare Provider Details

I. General information

NPI: 1811786932
Provider Name (Legal Business Name): MCKENNA RILEY MCGILL BARDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 S KOELLER ST
OSHKOSH WI
54902-5546
US

IV. Provider business mailing address

302 N JACKSON ST
MILWAUKEE WI
53202-5904
US

V. Phone/Fax

Practice location:
  • Phone: 844-493-1052
  • Fax:
Mailing address:
  • Phone: 602-881-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16615-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: