Joshua Jackson Selly, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN2303725 Issued in MA

Practice address

285 Plantation St Apt 627
Worcester, MA 01604-7715

Phone

(508) 736-3326

NPI assigned

Dec 3, 2021

Last updated

Dec 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Koann Therapeutic Services IncGroup PAC ID 7113302282, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Koann Therapeutic Services Inc

  dba Revive Therapeutic Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Providence, RI
  • NPI 1639843303
  Medicare reassignment Care Compare group NPD
• Koann Therapeutic Services Inc

  dba Revive Therapeutic Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Providence, RI
  • NPI 1629861224
  NPD (past)

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

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1205594579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 PLANTATION ST APT 627",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016047715",
            "telephone_number": "508-736-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 PLANTATION ST APT 627",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016047715",
            "telephone_number": "508-736-3326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELLY",
        "first_name": "JOSHUA",
        "middle_name": "JACKSON",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2303725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter James Sell, D.O.
• Noelle Catherine Sellars, ATC
• Jennifer Seller
• Sarah Gwen Sellers, CRNA
• Judy Ann Sellez
• Rita J Semaan
• Anevia Semiday
• Laureen Sena, MD
• Fnu Senin, MD
• Senior Residential Care/Worcester, Inc. (Wingate at Worcester)

• Psychiatric/Mental Health Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.