Provider Demographics
NPI:1427353283
Name:BALDWIN, SELENA LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:LEE
Last Name:BALDWIN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6021 COOPER DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3072
Mailing Address - Country:US
Mailing Address - Phone:601-394-9098
Mailing Address - Fax:
Practice Address - Street 1:2370 HILLCREST RD # TD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3841
Practice Address - Country:US
Practice Address - Phone:251-459-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-170904261Q00000X, 363LF0000X
MSR865284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02955271Medicaid
MS02955271Medicaid