Provider Demographics
NPI:1134973977
Name:SELVY, CATRINA EVETTE
Entity type:Individual
Prefix:
First Name:CATRINA
Middle Name:EVETTE
Last Name:SELVY
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 1:635 RIVERWEST CIR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9042
Mailing Address - Country:US
Mailing Address - Phone:501-350-0725
Mailing Address - Fax:
Practice Address - Street 1:635 RIVERWEST CIR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9042
Practice Address - Country:US
Practice Address - Phone:501-350-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR108805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily