Provider Demographics
NPI:1134164049
Name:SELLS, CAROL L
Entity type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:L
Last Name:SELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:GILILLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1930 BISHOP LANE
Practice Address - Street 2:SUITE 1600
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1948
Practice Address - Country:US
Practice Address - Phone:502-272-5044
Practice Address - Fax:502-272-5121
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2852891001OtherCIGNA
KY616846OtherACN
KYP-12003240OtherMEGA LIFE// MULTIPLAN
KY4400376OtherUNITED
KY5846723OtherAETNA
KY000000189377OtherANTHEM
KY1204346OtherCHA
KY2852891001OtherCIGNA
KY4400376OtherUNITED
KY5846723OtherAETNA