Provider Demographics
NPI:1396410502
Name:SELLERS, ROY D
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:D
Last Name:SELLERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SCHMETZER CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:NEBO
Mailing Address - State:KY
Mailing Address - Zip Code:42441-9751
Mailing Address - Country:US
Mailing Address - Phone:270-339-2693
Mailing Address - Fax:
Practice Address - Street 1:266 WATER ST
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038-7737
Practice Address - Country:US
Practice Address - Phone:270-388-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016464363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health