Healthcare Provider Details

I. General information

NPI: 1538403514
Provider Name (Legal Business Name): KATHERINE LYNN SELBY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LYNN HERBERGER APRN

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MITCHELLS CHANCE RD
EDGEWATER MD
21037-2787
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC006945
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007745
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: