Individual
JARED MICHAEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
10660 PARK RD STE 3400, CHARLOTTE, NC 28210-8461
(704) 667-3840
Mailing address
716 CODY CT, FORT MILL, SC 29715-7092
(234) 281-4781
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
57164
SC
Other
Enumeration date
05/11/2026
Last updated
05/11/2026
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