Healthcare Provider Details

I. General information

NPI: 1679116644
Provider Name (Legal Business Name): FELICIA SELLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 AMOCO DR
MOSS POINT MS
39563-9627
US

IV. Provider business mailing address

9304 BRIARCREST LN
VANCLEAVE MS
39565-8261
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-2494
  • Fax: 228-396-3457
Mailing address:
  • Phone: 228-522-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903800
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: