Basic Information
| Provider Information | |||||||||
| NPI: | 1477026029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLERS | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | JOYCE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 RIVER WILDE DR | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773163021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817707244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15882 CHAMPION FOREST DR | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773797141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817838162 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2019 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP139755 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.