Healthcare Provider Details

I. General information

NPI: 1720918519
Provider Name (Legal Business Name): SEAN DEVON JAMES EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE
SPRINGFIELD MO
65802-1988
US

IV. Provider business mailing address

1735 W BENNETT ST APT G103
SPRINGFIELD MO
65807-7843
US

V. Phone/Fax

Practice location:
  • Phone: 216-403-7139
  • Fax:
Mailing address:
  • Phone: 216-403-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB-80354
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: