Healthcare Provider Details

I. General information

NPI: 1669129193
Provider Name (Legal Business Name): TAMBRA L SELLERS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/18/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE STE 3300
SPRINGFIELD MO
65804-2246
US

IV. Provider business mailing address

2115 S FREMONT AVE STE 3300
SPRINGFIELD MO
65804-2246
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-5200
  • Fax: 417-820-5220
Mailing address:
  • Phone: 417-820-5200
  • Fax: 417-820-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022007575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: