Provider Demographics
NPI:1649390683
Name:SELLMAN, JENNIFER R (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:SELLMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1061 JONES ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3866
Mailing Address - Country:US
Mailing Address - Phone:573-888-0303
Mailing Address - Fax:573-888-0304
Practice Address - Street 1:1061 JONES ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3866
Practice Address - Country:US
Practice Address - Phone:573-888-0303
Practice Address - Fax:573-888-0304
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006013170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine