Individual
COLTON SELVIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(636) 386-7222
(636) 386-7222
Mailing address
PO BOX 22407, SAINT LOUIS, MO 63126-0407
(636) 386-7222
(636) 386-7810
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2021020995
MO
367500000X
Certified Registered Nurse Anesthetist
RN700062
PA
Other
Enumeration date
01/07/2020
Last updated
09/10/2021
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