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Organization
SHOAL CREEK FOOT AND ANKLE CENTER LLC
Active
Organization
SHOAL CREEK FOOT AND ANKLE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY DIANE SEDBERRY DPM (OWNER/PRESIDENT)
(417) 622-0648
Entity
Organization
Contact information
Practice address
1801 W 32ND ST STE 102, JOPLIN, MO 64804-1528
(417) 622-0648
(417) 622-0497
Mailing address
PO BOX 4427, JOPLIN, MO 64803-4427
(417) 622-0648
(417) 622-0497
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2018010120
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300054533
—
MO
Enumeration date
08/30/2018
Last updated
06/10/2025
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