1548934359 NPI number — CARLY R SELL PMHNP

Table of content: CARLY R SELL PMHNP (NPI 1548934359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548934359 NPI number — CARLY R SELL PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELL
Provider First Name:
CARLY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548934359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/03/2022
NPI Reactivation Date:
10/11/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 BUGLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59647-8512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-459-9227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 N RODNEY ST STE 4E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-459-9227
Provider Business Practice Location Address Fax Number:
406-634-3302
Provider Enumeration Date:
08/04/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  196374 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)