Individual
ANN WILSON ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
05172
OH
363L00000X
Nurse Practitioner
Primary
3003153
KY
363LA2100X
Acute Care Nurse Practitioner
3153
KY
363LA2100X
Acute Care Nurse Practitioner
NP-5172
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0369012
MEDICARE
KY
01
—
0562612
MEDICARE
KY
05
—
2383344
—
OH
01
—
611300608060
CARESOURCE
OH
05
—
78011780
—
KY
Enumeration date
07/05/2005
Last updated
02/15/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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