Provider Demographics
NPI:1093972499
Name:SELLERS, LISA J (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:SELLERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0550
Mailing Address - Country:US
Mailing Address - Phone:828-321-4510
Mailing Address - Fax:828-321-3973
Practice Address - Street 1:2751 BUSINESS HWY 19
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901
Practice Address - Country:US
Practice Address - Phone:828-321-4510
Practice Address - Fax:828-321-3973
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant