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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