Provider Demographics
NPI:1134785553
Name:SELLERS, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 OAK PARK LN UNIT 100772
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-2234
Mailing Address - Country:US
Mailing Address - Phone:817-524-8135
Mailing Address - Fax:
Practice Address - Street 1:4407 BELLAIRE DR S APT 216
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5104
Practice Address - Country:US
Practice Address - Phone:817-524-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant