Provider Demographics
NPI:1043606056
Name:SELLERS, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W CHEROKEE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5616
Mailing Address - Country:US
Mailing Address - Phone:580-297-5125
Mailing Address - Fax:580-297-5125
Practice Address - Street 1:317 W CHEROKEE AVE STE B
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5616
Practice Address - Country:US
Practice Address - Phone:580-297-5125
Practice Address - Fax:580-297-5125
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V312690404376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide