Healthcare Provider Details

I. General information

NPI: 1831662337
Provider Name (Legal Business Name): SEANNA PAIGE STEVENSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W CLAY RD
VERSAILLES MO
65084-1177
US

IV. Provider business mailing address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-2349
  • Fax: 866-208-0157
Mailing address:
  • Phone: 660-826-4774
  • Fax: 660-827-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018034767
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: