Healthcare Provider Details

I. General information

NPI: 1073296174
Provider Name (Legal Business Name): KIMBERLY DAWN SEEVERS FNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E WOODHURST DR STE A400
SPRINGFIELD MO
65804-3746
US

IV. Provider business mailing address

1200 E WOODHURST DR STE A400
SPRINGFIELD MO
65804-3746
US

V. Phone/Fax

Practice location:
  • Phone: 417-470-1633
  • Fax:
Mailing address:
  • Phone: 417-470-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023032273
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: