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General NPI Number Information
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NPI Number | 1255720876
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Entity Type | Individual
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Provider Name | STACY LEIGH SEDERWALL FNP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 2840 BAGNELL DAM BLVD
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City | LAKE OZARK
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State | MO
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Zip | 65049-9732
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Country | US
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Telephone | 573-480-8888
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Fax | 502-399-8745
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Provider Business Mailing Address
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Address Line | 2840 BAGNELL DAM BLVD
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City | LAKE OZARK
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State | MO
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Zip | 65049-9732
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Country | US
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Telephone | 573-480-8888
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Fax | 502-399-8745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015001255
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License Number State | MO
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