Individual
TYLER ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 25TH ST, ASHLAND, KY 41101-7820
(866) 233-1955
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(063) 298-5886
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
299696
KY
Other
Enumeration date
07/09/2024
Last updated
06/10/2025
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