Individual
JACOB SHANE SELLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1024 EUCLID PL, HUNTINGTON, WV 25701-3536
(304) 942-2344
Mailing address
1024 EUCLID PL, HUNTINGTON, WV 25701-3536
(304) 942-2344
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
103379
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2022
Last updated
06/26/2024
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