Individual
KIMBERLY CAROL ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
770 W RIDGE RD STE 220, WYTHEVILLE, VA 24382-1187
(276) 223-3202
Mailing address
770 W RIDGE RD, WYTHEVILLE, VA 24382-1187
(276) 223-3200
(276) 223-0617
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024167810
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205094174
—
VA
05
—
Q008296
—
TN
Enumeration date
05/28/2008
Last updated
10/26/2021
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