MEDICARE: STEPHANIE SELLS F.N.P.

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	163W00000X	Registered Nurse	165326	TN
2	363LP2300X	Primary Care Nurse Practitioner	18502	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770908998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SELLS F.N.P.

Provider Business Mailing Address
First Line	:	201 S FRONT ST
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1547
Country	:	US
Telephone Number	:	731-836-5617
Fax Number	:	731-836-5284

Provider Business Practice Location Address
First Line	:	201 S FRONT ST
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1547
Country	:	US
Telephone Number	:	731-836-5617
Fax Number	:	731-836-5284

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

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	01/28/2015

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Directions to “ STEPHANIE SELLS F.N.P.” Practice Location

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