Provider Demographics
NPI:1932484391
Name:MCCLANAHAN, SELLERS WESTOVER (PA)
Entity Type:Individual
Prefix:
First Name:SELLERS
Middle Name:WESTOVER
Last Name:MCCLANAHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SELLERS
Other - Middle Name:
Other - Last Name:WESTOVER-SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 EVANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1882
Mailing Address - Country:US
Mailing Address - Phone:985-869-8853
Mailing Address - Fax:
Practice Address - Street 1:250 EVANGELINE DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1882
Practice Address - Country:US
Practice Address - Phone:985-869-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2173146Medicaid
LA2173146Medicaid