Provider Demographics
NPI:1457326738
Name:SELLERS, CATHARINE EVELYN (C-A/GNP)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:EVELYN
Last Name:SELLERS
Suffix:
Gender:F
Credentials:C-A/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3525 S NATIONAL AVE STE 205A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7315
Practice Address - Country:US
Practice Address - Phone:417-269-9220
Practice Address - Fax:417-269-9229
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016036036363LA2200X
MNR1587920363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN817933600Medicaid