Provider Demographics
NPI:1205466984
Name:SELLERS, RACHEL M (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:SELLERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 MANGUM DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-2113
Mailing Address - Country:US
Mailing Address - Phone:601-586-7070
Mailing Address - Fax:601-586-7071
Practice Address - Street 1:4436 MANGUM DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-2113
Practice Address - Country:US
Practice Address - Phone:601-586-7070
Practice Address - Fax:601-586-7071
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00469363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS64-0604703Medicaid