Provider Demographics
NPI:1811555881
Name:SELLERS, JEREMY DELL (LVN)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DELL
Last Name:SELLERS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3222
Mailing Address - Country:US
Mailing Address - Phone:940-730-5602
Mailing Address - Fax:
Practice Address - Street 1:1104 FRANCES ST
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3222
Practice Address - Country:US
Practice Address - Phone:940-730-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198497164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse