Provider Demographics
NPI:1831293547
Name:MCFADDEN, RODNEY K (CRNA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:K
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-9007
Mailing Address - Country:US
Mailing Address - Phone:417-239-3392
Mailing Address - Fax:417-239-3394
Practice Address - Street 1:525 BRANSON LANDING BLVD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2052
Practice Address - Country:US
Practice Address - Phone:417-239-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO065906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20174319965616B006OtherTRICARE
MO5277OtherCOX HEALTH
OK100786870BMedicaid
MO401097OtherHEALTHLINK
AR125331701Medicaid
MO912808052Medicaid
MO1831293547Medicaid
MOP00267912OtherRAILROAD
MO194111OtherBCBS