Provider Demographics
NPI:1336392430
Name:SELLERS, CAROL A (NP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:SELLERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FAMILY PRACTICE DR
Mailing Address - Street 2:N/A
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6449
Mailing Address - Country:US
Mailing Address - Phone:845-338-6400
Mailing Address - Fax:
Practice Address - Street 1:1 FAMILY PRACTICE DRIVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2832
Practice Address - Country:US
Practice Address - Phone:845-338-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304927-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30000001SVJQEA0Medicaid