Provider Demographics
NPI:1073020673
Name:SELSOR, KATRINA LEA (NP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LEA
Last Name:SELSOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2183 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-8813
Mailing Address - Country:US
Mailing Address - Phone:417-880-2505
Mailing Address - Fax:417-634-4505
Practice Address - Street 1:155 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-8104
Practice Address - Country:US
Practice Address - Phone:417-634-4203
Practice Address - Fax:417-634-4505
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018000302363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care