Provider Demographics
NPI:1538403514
Name:SELBY, KATHERINE LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LYNN
Last Name:SELBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LYNN
Other - Last Name:HERBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:137 MITCHELLS CHANCE RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2787
Practice Address - Country:US
Practice Address - Phone:410-955-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC006945363LF0000X
KY3007745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY143386OtherSIHO - NCMA
KY7100227850Medicaid
KY50044934OtherPASSPORT - NCMA
IN201130600Medicaid
KY000000797018OtherANTHEM - NCMA
KY7100227850Medicaid