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1639906787 NPI number — DESTINY E SELLERS PMHNP-BC

NPI Number: 1639906787
Health Care Provider/Practitioner: DESTINY E SELLERS PMHNP-BC

Information about “1639906787” NPI (DESTINY E SELLERS PMHNP-BC) exists in 1639906787 in HTML format HTML  |  1639906787 in plain Text format TXT  |  1639906787 in PDF (Portable Document Format) PDF  |  1639906787 in an XML format XML  formats.

NPI Number : 1639906787 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639906787",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SELLERS",
    "FirstName": "DESTINY",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PMHNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2001 CLUB MANOR DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAUMELLE",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72113-7777",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-734-8085",
    "MailingAddressFaxNumber": "501-734-8088",
    "FirstLinePracticeLocationAddress": "2001 CLUB MANOR DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MAUMELLE",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72113-7777",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "501-734-8085",
    "PracticeLocationAddressFaxNumber": "501-734-8088",
    "EnumerationDate": "09/13/2024",
    "LastUpdateDate": "01/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WC0200X",
          "TaxonomyName": "Critical Care Medicine Registered Nurse",
          "LicenseNumber": "R099041",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
          "LicenseNumber": "R099041",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "230665",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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