MEDICARE: MRS. PARIS A. R. SELLERS PA-C

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	363A00000X	Physician Assistant	0010-07549	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TL3114	OTHER	SC	SC LICENSE

General Provider Information

NPI Number	:	1891210712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PARIS A. R. SELLERS PA-C

Provider Business Mailing Address
First Line	:	3521 GRAYSTONE PL SE STE 202
Second Line	:
City	:	CONOVER
State	:	NC
Zip	:	28613-8269
Country	:	US
Telephone Number	:	828-732-5700
Fax Number	:	828-732-5701

Provider Business Practice Location Address
First Line	:	3521 GRAYSTONE PL SE STE 202
Second Line	:
City	:	CONOVER
State	:	NC
Zip	:	28613-8269
Country	:	US
Telephone Number	:	828-732-5700
Fax Number	:	828-732-5701

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	10/21/2022

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