Provider Demographics
NPI:1194231472
Name:SELL, KIMBERLY FAY (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAY
Last Name:SELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15213 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1078
Mailing Address - Country:US
Mailing Address - Phone:734-344-2063
Mailing Address - Fax:
Practice Address - Street 1:205 EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49261
Practice Address - Country:US
Practice Address - Phone:517-205-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704283825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily