=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386591923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELAH WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2307 S CAMPBELL AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-2971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-696-6015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 544 S CHARLOTTE CT
-----------------------------------------------------
City | REPUBLIC
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65738-7590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-696-6015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JENNIFER BETH REGAN
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 760-696-6015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------