Healthcare Provider Details

I. General information

NPI: 1457326738
Provider Name (Legal Business Name): CATHARINE EVELYN SELLERS C-A/GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 S NATIONAL AVE STE 205A
SPRINGFIELD MO
65807-7315
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-9220
  • Fax: 417-269-9229
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2016036036
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: