Healthcare Provider Details

I. General information

NPI: 1730951849
Provider Name (Legal Business Name): KARA MARIE SELBY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA PRYTULA

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 MCCARTY LN
LAFAYETTE IN
47905-8764
US

IV. Provider business mailing address

6755 DORCHESTER DR
ZIONSVILLE IN
46077-9162
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000446A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number09000446A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: