Provider Demographics
NPI:1366294696
Name:WEISSEND, MADALYN ANNE (APRN)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:ANNE
Last Name:WEISSEND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:ANNE
Other - Last Name:STORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-685-8230
Mailing Address - Fax:270-685-8233
Practice Address - Street 1:1200 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1089
Practice Address - Country:US
Practice Address - Phone:270-685-8230
Practice Address - Fax:270-685-8233
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4024272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300093154Medicaid
KYK0013818OtherMEDICARE KY
KY7100996290Medicaid