Healthcare Provider Details

I. General information

NPI: 1720011869
Provider Name (Legal Business Name): CAROLYN LOUISE SEIFERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN L ESCOTT

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 COMMUNICATION DR
HANNIBAL MO
63401-3670
US

IV. Provider business mailing address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 573-603-1460
  • Fax: 573-603-1462
Mailing address:
  • Phone: 660-665-1962
  • Fax: 660-665-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32701
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.098923
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR2J61
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: