Healthcare Provider Details

I. General information

NPI: 1760905756
Provider Name (Legal Business Name): JENNIFER NICOLE SELBY RN, AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MARYS AVE
KINGSTON NY
12401-5829
US

IV. Provider business mailing address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-2500
  • Fax:
Mailing address:
  • Phone: 845-454-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431159
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14790
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: