Healthcare Provider Details

I. General information

NPI: 1710392865
Provider Name (Legal Business Name): LATOYA SELVY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W HARRISON AVE
WEST MEMPHIS AR
72301-4230
US

IV. Provider business mailing address

204 MISSISSIPPI ST S
WYNNE AR
72396-3025
US

V. Phone/Fax

Practice location:
  • Phone: 870-559-2222
  • Fax:
Mailing address:
  • Phone: 870-208-8499
  • Fax: 870-587-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: