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General NPI Number Information
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NPI Number | 1134031263
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Entity Type | Individual
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Provider Name | BENJAMIN SELBY
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Gender | Male
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 11492 BLUEGRASS PKWY STE 108
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City | LOUISVILLE
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State | KY
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Zip | 40299-2334
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Country | US
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Telephone | 502-254-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 453 WILLOWBROOK DR
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City | FISHERVILLE
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State | KY
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Zip | 40023-8451
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Country | US
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Telephone | 502-356-0809
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4063926
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License Number State | KY
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