Provider Demographics
NPI:1740288638
Name:SELLERS, DAVID F (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:SELLERS
Suffix:
Gender:M
Credentials:CRNA
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 988
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75504-0988
Mailing Address - Country:US
Mailing Address - Phone:903-793-7994
Mailing Address - Fax:903-793-7996
Practice Address - Street 1:4080 SUMMERHILL SQ
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2730
Practice Address - Country:US
Practice Address - Phone:903-793-7994
Practice Address - Fax:903-793-7996
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIAP101349367500000X
TX235571367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84293COtherBLUE CROSS
AR97081OtherBLUE CROSS
TX109670303Medicaid
AR128073701Medicaid
TX84293CMedicare ID - Type Unspecified
AR128073701Medicaid