Healthcare Provider Details

I. General information

NPI: 1134836406
Provider Name (Legal Business Name): ELAINA SELLS ADAMS PA-C LAT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINA ANITA SELLS

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

9618 NE 97TH ST
KANSAS CITY MO
64157-6243
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax:
Mailing address:
  • Phone: 660-998-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: