Individual
KRISTIN KAY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 PARKERS MILL RD, SOMERSET, KY 42501-3152
(606) 679-7348
Mailing address
130 SOUTHERN SCHOOL RD, SOMERSET, KY 42501-3223
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
08/15/2017
Last updated
06/05/2019
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