MEDICARE: DR. KRISTIE KAY SELLERS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist		AK
2	103T00000X	Psychologist	554	AK

General Provider Information

NPI Number	:	1245203918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIE KAY SELLERS PHD

Provider Business Mailing Address
First Line	:	PO BOX 2803
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-2803
Country	:	US
Telephone Number	:	907-260-1944
Fax Number	:	907-714-4649

Provider Business Practice Location Address
First Line	:	245 N BINKLEY ST STE 202
Second Line	:
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7500
Country	:	US
Telephone Number	:	907-714-4521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	04/20/2021

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