Individual provider Active NPI

McKenna Glyn Madche, FNP

  • Primary Care Nurse Practitioner
  • Ava, MO
National Provider Identifier
1093513087
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
2025006229 Issued in MO
Practice address
504 W Broadway Ave
Ava, MO 65608
Phone
(417) 683-5739
NPI assigned
Mar 5, 2025
Last updated
Mar 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 2025006229 MO Primary

Addresses

Primary practice location

504 W Broadway Ave
Ava, MO 65608

Mailing address

504 S Sarah Ave
Republic, MO 65738-2693
Phone (573) 953-9939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250507000234 MO Practitioner - Nurse Practitioner 7517484249 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

504 W Broadway Ave
Missouri Ozarks Community Health
Ava, MO 65608-1359
Phone (417) 683-5739

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas County Public Health Services Group, Inc. CurrentSince Apr 4, 2025 Accepting new patients
Douglas County Public Health Services Group, Inc. CurrentSince Apr 4, 2025 Accepting new patients
Douglas County Public Health Services Group, Inc. Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
Douglas County Public Health Services Group, Inc. PastSince Mar 11, 2025 Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1093513087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S SARAH AVE",
            "city": "REPUBLIC",
            "state": "MO",
            "postal_code": "657382693",
            "telephone_number": "573-953-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W BROADWAY AVE",
            "city": "AVA",
            "state": "MO",
            "postal_code": "65608",
            "telephone_number": "417-683-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADCHE",
        "first_name": "MCKENNA",
        "middle_name": "GLYN",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "2025006229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ava, MO

Sources for this page

Verify at the official NPI Registry.