Provider Demographics
NPI:1083355986
Name:KEARNEY, MADISON LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SW 107TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5244
Mailing Address - Country:US
Mailing Address - Phone:405-735-9788
Mailing Address - Fax:405-735-9882
Practice Address - Street 1:3960 W TECUMSEH RD STE 120
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1787
Practice Address - Country:US
Practice Address - Phone:405-217-3886
Practice Address - Fax:405-217-3418
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program