Individual
MISTY D ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
231 E CHESTNUT ST, LOUISVILLE, KY 40202-1821
(502) 629-6000
(502) 629-5865
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
3005293
KY
363LP0200X
Pediatric Nurse Practitioner
3005293
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200892820
—
IN
05
—
7100026490
—
KY
Enumeration date
06/04/2007
Last updated
07/21/2023
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