MEDICARE: SELAH WELLNESS, LLC

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	2083P0901X	Public Health & General Preventive Medicine Physician
2	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1386591923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELAH WELLNESS, LLC

Provider Business Mailing Address
First Line	:	544 S CHARLOTTE CT
Second Line	:
City	:	REPUBLIC
State	:	MO
Zip	:	65738-7590
Country	:	US
Telephone Number	:	760-696-6015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1839B E INDEPENDENCE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-3753
Country	:	US
Telephone Number	:	417-216-0257
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JENNIFER BETH REGAN
Credential	:	NP
Telephone Number	:	760-696-6015

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	06/02/2026

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