Healthcare Provider Details

I. General information

NPI: 1124937149
Provider Name (Legal Business Name): KELSEY LEIGH SEWARD NBSTSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

4043 NIGHTHAWK RD
DIAMOND MO
64840-8336
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-2403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number188246
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: