MEDICARE: MRS. AMELIA K SELPH APRN, ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	APN955	SC

General Provider Information

NPI Number	:	1053386706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMELIA K SELPH APRN, ACNP

Provider Business Mailing Address
First Line	:	3045 ST MATTHEWS RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8201
Country	:	US
Telephone Number	:	803-747-7242
Fax Number	:	803-747-7243

Provider Business Practice Location Address
First Line	:	3045 ST MATTHEWS RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8201
Country	:	US
Telephone Number	:	803-747-7242
Fax Number	:	803-747-7243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/19/2019

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