Provider Demographics
NPI:1528418357
Name:SELLERS, JAMES MADDERN IV
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MADDERN
Last Name:SELLERS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:MADDERN
Other - Last Name:SELLERS
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:12598 EMERALD COAST PKWY W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-2101
Mailing Address - Country:US
Mailing Address - Phone:850-654-8878
Mailing Address - Fax:
Practice Address - Street 1:12598 EMERALD COAST PKWY W
Practice Address - Street 2:SUITE 101
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-2101
Practice Address - Country:US
Practice Address - Phone:850-654-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9267401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily