Provider Demographics
NPI:1679301402
Name:SEYMOUR, BRISTOL W (FNP-C)
Entity type:Individual
Prefix:
First Name:BRISTOL
Middle Name:W
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRISTOL
Other - Middle Name:WYNNE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E RED BRIDGE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4030
Mailing Address - Country:US
Mailing Address - Phone:913-681-2398
Mailing Address - Fax:913-681-2416
Practice Address - Street 1:400 E RED BRIDGE RD STE 207
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4030
Practice Address - Country:US
Practice Address - Phone:913-681-2398
Practice Address - Fax:913-681-2416
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83405-092363LF0000X
MO2024031044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily