Healthcare Provider Details

I. General information

NPI: 1639906787
Provider Name (Legal Business Name): DESTINY E SELLERS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CLUB MANOR DR
MAUMELLE AR
72113-7777
US

IV. Provider business mailing address

2001 CLUB MANOR DR
MAUMELLE AR
72113-7777
US

V. Phone/Fax

Practice location:
  • Phone: 501-734-8085
  • Fax: 501-734-8088
Mailing address:
  • Phone: 501-734-8085
  • Fax: 501-734-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number230665
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR099041
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR099041
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: