Individual
MCKENNA GLYN MADCHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
504 W BROADWAY AVE, AVA, MO 65608
(417) 683-5739
Mailing address
504 S SARAH AVE, REPUBLIC, MO 65738-2693
(573) 953-9939
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
2025006229
MO
Other
Enumeration date
03/05/2025
Last updated
03/05/2025
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