Healthcare Provider Details

I. General information

NPI: 1699088278
Provider Name (Legal Business Name): DEBRA LORENE STEDEM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 HARVEST HILLS DR
CARROLLTON MO
64633-2412
US

IV. Provider business mailing address

819 S BUSINESS HIGHWAY 13
LEXINGTON MO
64067-1515
US

V. Phone/Fax

Practice location:
  • Phone: 877-344-3572
  • Fax: 866-228-4492
Mailing address:
  • Phone: 660-259-2440
  • Fax: 660-251-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010023602
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: