Individual
KEIDRA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1900 BLUEGRASS AVE, LOUISVILLE, KY 40215-1144
(502) 599-9397
Mailing address
920 OAK ST APT 107, EVANSVILLE, IN 47713-1863
(812) 456-6320
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
28221650A
IN
Other
Enumeration date
02/29/2024
Last updated
03/01/2024
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