Healthcare Provider Details

I. General information

NPI: 1881320414
Provider Name (Legal Business Name): ROBERT KEETHAN SELLERS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 W 16TH ST UNIT D
SAFFORD AZ
85546-0842
US

IV. Provider business mailing address

2175 W 16TH ST UNIT D
SAFFORD AZ
85546-0842
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-1600
  • Fax: 844-271-2379
Mailing address:
  • Phone: 928-348-1600
  • Fax: 844-271-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number278357
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN211986
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: