Provider Demographics
NPI:1083296057
Name:DIABETES WELLNESS NP, PLLC
Entity Type:Organization
Organization Name:DIABETES WELLNESS NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NYKKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:901-249-0755
Mailing Address - Street 1:700 N MISSOURI ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3150
Mailing Address - Country:US
Mailing Address - Phone:901-249-0755
Mailing Address - Fax:
Practice Address - Street 1:700 N MISSOURI ST STE 2
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3150
Practice Address - Country:US
Practice Address - Phone:870-551-4409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health