Provider Demographics
NPI:1639906787
Name:SELLERS, DESTINY E (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:E
Last Name:SELLERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CLUB MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7777
Mailing Address - Country:US
Mailing Address - Phone:501-734-8085
Mailing Address - Fax:501-734-8088
Practice Address - Street 1:2001 CLUB MANOR DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7777
Practice Address - Country:US
Practice Address - Phone:501-734-8085
Practice Address - Fax:501-734-8088
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR099041163WC0200X, 163WP0808X
AR230665363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health