Provider Demographics
NPI:1033922604
Name:SELLEY, MADDISON PEARL (FNP-C)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:PEARL
Last Name:SELLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 M ST
Mailing Address - Street 2:
Mailing Address - City:LAKE LOTAWANA
Mailing Address - State:MO
Mailing Address - Zip Code:64086-9441
Mailing Address - Country:US
Mailing Address - Phone:816-503-1578
Mailing Address - Fax:
Practice Address - Street 1:110 NE SAINT LUKES BLVD STE 530
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6075
Practice Address - Country:US
Practice Address - Phone:816-554-3838
Practice Address - Fax:816-554-1634
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025002303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily