Provider Demographics
NPI:1588424204
Name:SELLS, BRAD ALAN (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:ALAN
Last Name:SELLS
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-6171
Mailing Address - Country:US
Mailing Address - Phone:931-644-5177
Mailing Address - Fax:
Practice Address - Street 1:1003 RESERVE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-3084
Practice Address - Country:US
Practice Address - Phone:931-388-8965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant