Healthcare Provider Details

I. General information

NPI: 1164508065
Provider Name (Legal Business Name): KATHY A SELVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY A SIMPKINS

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IMA-EUROPE ATTN: SFIM-EU-HR (SAIC-ASACS) UNIT 29353, BOX 200
APO AE
09014-9353
US

IV. Provider business mailing address

CMR 420 BOX 2674
APO AE
09063
US

V. Phone/Fax

Practice location:
  • Phone: 496221163912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0010165
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW08302
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: