Provider Demographics
NPI:1225622392
Name:SELLERS, SHAYLA MOORE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:MOORE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GABRIEL LN
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-5778
Mailing Address - Country:US
Mailing Address - Phone:912-278-6120
Mailing Address - Fax:
Practice Address - Street 1:950 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0161
Practice Address - Country:US
Practice Address - Phone:912-367-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily