Provider Demographics
NPI:1427309962
Name:SELBY, CARYN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:MARIE
Last Name:SELBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:MARIE
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9311
Mailing Address - Fax:812-426-9839
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9311
Practice Address - Fax:812-426-9839
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001512A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant