Provider Demographics
NPI:1659854131
Name:SELBY, CAROL LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:SELBY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 E CAMELBACK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4418
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:6020 E ARBOR AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6102
Practice Address - Country:US
Practice Address - Phone:480-985-1700
Practice Address - Fax:480-396-3659
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily