Provider Demographics
NPI:1043250749
Name:SELMON, CLAYBRA N
Entity type:Individual
Prefix:
First Name:CLAYBRA
Middle Name:N
Last Name:SELMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5199
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5199
Mailing Address - Country:US
Mailing Address - Phone:325-437-8300
Mailing Address - Fax:325-437-8399
Practice Address - Street 1:1706 W CHESTNUT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76203
Practice Address - Country:US
Practice Address - Phone:940-565-2333
Practice Address - Fax:940-565-3190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX714316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily