Provider Demographics
NPI:1881320414
Name:SELLERS, ROBERT KEETHAN (PMHNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEETHAN
Last Name:SELLERS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 W 16TH ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-0842
Mailing Address - Country:US
Mailing Address - Phone:928-348-1600
Mailing Address - Fax:844-271-2379
Practice Address - Street 1:2175 W 16TH ST UNIT D
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-0842
Practice Address - Country:US
Practice Address - Phone:928-348-1600
Practice Address - Fax:844-271-2379
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN211986163W00000X
AZ278357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse