Healthcare Provider Details

I. General information

NPI: 1508731100
Provider Name (Legal Business Name): ALYSSA SEQUEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E EUCLID ST
MCPHERSON KS
67460-3847
US

IV. Provider business mailing address

1600 E EUCLID ST
MCPHERSON KS
67460-3847
US

V. Phone/Fax

Practice location:
  • Phone: 800-365-7402
  • Fax:
Mailing address:
  • Phone: 800-365-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01867
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: