Individual
JACQUELINE MARIE SELPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15 MARKET CENTER DR STE A, FLAT ROCK, NC 28731-8529
(286) 978-1170
(828) 698-4939
Mailing address
15 MARKET CENTER DR STE A, FLAT ROCK, NC 28731-8529
(828) 697-1170
(828) 698-4939
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2019-00922
NC
207N00000X
Dermatology Physician
D84894
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006815480
UHC
NC
01
—
205L8
BCBS NC
NC
01
—
NN9352F459
MEDICARE
NC
01
—
P02346770
RAILROAD MEDICARE
NC
Enumeration date
04/16/2013
Last updated
07/17/2020
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