MEDICARE: MADISON CUNNINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	5385070012	KS

General Provider Information

NPI Number	:	1962367664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON CUNNINGHAM

Provider Business Mailing Address
First Line	:	12401 W 119TH PL APT 1327
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66213-5743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E RED BRIDGE RD STE 207
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4030
Country	:	US
Telephone Number	:	913-681-2398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ MADISON CUNNINGHAM ” Practice Location

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