Individual
ELLA MARIE CALLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1611 S BALTIMORE ST STE A, KIRKSVILLE, MO 63501
(660) 665-7575
(660) 665-7576
Mailing address
1611 S BALTIMORE ST STE A, KIRKSVILLE, MO 63501-4519
(660) 665-7575
(660) 665-7576
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.003797
IL
363A00000X
Physician Assistant
Primary
2012008168
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497069694
—
MO
Enumeration date
07/29/2010
Last updated
10/18/2018
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