Healthcare Provider Details

I. General information

NPI: 1295121622
Provider Name (Legal Business Name): SETH SNOWDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E CLEVELAND ST
MONETT MO
65708-6149
US

IV. Provider business mailing address

210 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 417-236-2600
  • Fax:
Mailing address:
  • Phone: 417-269-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015003910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: