Individual
JESSICA DANIELLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
571 S ALLEN RD, FLAT ROCK, NC 28731-9447
(828) 692-6178
Mailing address
571 S ALLEN RD, FLAT ROCK, NC 28731-9447
(828) 692-6178
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
174165
NC
363LG0600X
Gerontology Nurse Practitioner
Primary
174165
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245659705
—
NC
05
—
NP2800
—
SC
Enumeration date
04/14/2014
Last updated
08/17/2022
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