Individual
MR. TIMOTHY LYLE SELLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
395 W COUGAR BLVD STE 602, PROVO, UT 84604-3331
(801) 257-7250
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 373-3300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9186424-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9186424-4405
APRN LICENSE
UT
01
—
95009908
NURSE PRACTITIONER LICENSE
CA
Enumeration date
09/25/2018
Last updated
03/07/2023
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