Provider Demographics
NPI:1922881275
Name:MARMILLION-EGBY, SELECIA JOY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SELECIA
Middle Name:JOY
Last Name:MARMILLION-EGBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 JACK MILLER RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5607
Mailing Address - Country:US
Mailing Address - Phone:337-363-7036
Mailing Address - Fax:337-363-6203
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4618
Practice Address - Country:US
Practice Address - Phone:337-363-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2321372084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry