Selina Louise Broadaway, CPNP-AC

Primary specialty

Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X

License

31660 Issued in TN

Practice address

262 Danny Thomas PL
Memphis, TN 38105-3678

Phone

(888) 226-4343

NPI assigned

May 16, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Selina Louise Ribnick Former name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Jude Children'S Research Hospital, Inc.

  • Pediatrics Physician
  • Memphis, TN
  • NPI 1306335088
  Medicare reassignment NPD
• Ut Lebonheur Pediatric Specialists, Inc.

  • Pediatrics Physician
  • Memphis, TN
  • NPI 1093024101
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1124765714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "848 ADAMS AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032816",
            "telephone_number": "901-661-3719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 DANNY THOMAS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381053678",
            "telephone_number": "888-226-4343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "848 Adams Ave Fl 6",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381032816",
            "country_code": "US",
            "telephone_number": "901-661-3719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADAWAY",
        "first_name": "SELINA",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "CPNP-AC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-16",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "TN",
            "license": "31660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SELINA",
            "last_name": "RIBNICK",
            "middle_name": "LOUISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrew M Brittan, MD
• Brittanys Esther House
• Judith Berner Brittingham, NP
• Aretha Britton
• Philanda Denise Britton
• Melissa Broaddus, O.D.
• Angela Broadway, PHARMD
• Jeanetta Marie Broadway
• Broc Medical Supply Co.
• Broca Inpatient Services

• Critical Care Pediatric Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Critical Care Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.