Healthcare Provider Details

I. General information

NPI: 1386591923
Provider Name (Legal Business Name): SELAH WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 S CAMPBELL AVE
SPRINGFIELD MO
65807-2971
US

IV. Provider business mailing address

544 S CHARLOTTE CT
REPUBLIC MO
65738-7590
US

V. Phone/Fax

Practice location:
  • Phone: 760-696-6015
  • Fax:
Mailing address:
  • Phone: 760-696-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER BETH REGAN
Title or Position: OWNER
Credential: NP
Phone: 760-696-6015