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General NPI Number Information
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NPI Number | 1306537634
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Entity Type | Individual
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Provider Name | MADISON RAE NEWELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 7201 E 147TH ST
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City | GRANDVIEW
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State | MO
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Zip | 64030-4204
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Country | US
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Telephone | 816-348-2260
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Fax | 913-495-3751
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Provider Business Mailing Address
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Address Line | 8550 MARSHALL DR STE 220
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City | LENEXA
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State | KS
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Zip | 66214-9836
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Country | US
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Telephone | 163-482-2608
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Fax | 913-495-3751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-02806
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2023038572
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License Number State | MO
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