Provider Demographics
NPI:1497595938
Name:MADDOX, MCKAYLA RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:RENEE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MCKAYLA
Other - Middle Name:RENEE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5228
Mailing Address - Fax:573-331-5073
Practice Address - Street 1:3250 GORDONVILLE RD STE 301
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5095
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:573-331-4130
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024018669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily