Healthcare Provider Details

I. General information

NPI: 1477495117
Provider Name (Legal Business Name): REAGAN SELLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 23RD AVE
MERIDIAN MS
39301-4026
US

IV. Provider business mailing address

PO BOX 223
MACON MS
39341-0223
US

V. Phone/Fax

Practice location:
  • Phone: 601-531-3969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908334
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: